Biennial report of the North Carolina State Board of Health

THIRTEENTH BIENNIAL REPORT
OF THE
NORTH CAROLINA STATE BOARD OF HEALTH
1909-1910
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1909-10
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DANiEL & WARREN
THIRTEENTH BIENNIAL REPORT
OF THE
NORTH CAROLINA
STATE BOARD OF HEALTH
1909-MO
RALEIGH
Edwards & Broughton Printing Co., State Printers
1911
Members
G. G. Thomas, M.D., Pies., Wilmington.
Thomas E. Axdersox, M.D., Statesville.
J. Howell Way, M.D., Waynesville.
W. 0. Spexcer, M.D., Winston-Salem.
Edw. C. Register, M.D., Charlotte.
David T. Tayloe, M.D., Washington.
*J. A. Burroughs, M.D., Asheville.
J. L. Ludlow, C.E., Winston-Salem.
Richard H. Lewis, M.D., Raleigh.
•Deceased. Succeeded by J. E. Asheraft M.D.. Monroe.
County Superintendents of Health
Alamance Dr. G.
Alexander Dr. 0.
Alleghany Dr. B.
Anson Dr. J.
Ashe Dr. J.
Beaufort Dr. P.
Bertie Dr. J.
Bladen Dr. L.
Brunswick Dr. J.
Buncombe Dr. D.
Burke Dr. I.
Cabarrus Dr. J.
Caldwell Dr. C.
Camden Dr. C.
Carteret Dr. W
Caswell Dr. S.
Catawba Dr. H.
Chatham Dr. L.
Cherokee Dr. J.
( lmwan Dr. H.
Clay Dr. J.
Cleveland Dr. T.
Columbus Dr. H.
Craven Dr. J.
Cuml>erland Dr. W,
Currituck Dr. H.
Dare Dr. . .
Davidson Dr. E.
Davie Dr. M
Duplin Dr. T.
Durham Dr. X.
Edgecombe Dr. S.
Forsyth Dr. J.
Franklin Dr. J.
Gaston Dr. X.
Gates Dr. G.
Graham Dr. M.
Granville Dr. S.
Greene Dr. W
Guilford Dr. A.
Halifax Dr. I.
Harnett Dr. L.
Haywood Dr. J.
Henderson Dr. J.
Hertford Dr. J.
Hyde Dr. K
W. Long Graham.
L. Hollar Taylorsville.
0. Choat Sparta.
M. Covington Wadesboro.
C. Testerman Jefferson.
A. Nicholson Washington.
L. Pritchard Windsor.
B. Evans Clarkton.
A. Dosher Southport.
E. Sevier Asheville.
W. Phifer Morganton.
W. Wallace Concord.
L. Wilson Lenoir.
G. Ferebee Gregory.
E. Headen Morehead City.
A. Malloy Yanceyville.
E. Rowe Newton.
E. Farthing Pittsboro.
F. Abernethy Murphy.
M. S. Cason Edenton.
M. Sullivan Hayesville.
E. McBrayer Shelby.
B. Maxwell Whiteville.
F. Rhem Xew Bern.
S. Jordan Fayetteville.
M. Shaw Shawboro.
J. Buchanan Lexington.
. D. Kimbrough Moeksville.
O. Coppedge Kenansville.
M. Johnson Durham.
P. Bass Tarboro.
K. Pepper Winston.
E. Malone Louisburg.
L. Glenn Gastonia.
D. Williams Gatesville.
T. Maxwell Robbinsville.
D. Booth Oxford.
. B. Murphy Snow Hill.
T. Fortune Greensboro.
E. Green Weldon.
F. Arnold Lillington.
R. McCracken Waynesville.
G. Waldrop Hendersonville.
H. Mitchell Ahoskie.
E. Windlev Lake Landing.
Iredell Dr. M. E. Adams Statesville.
Jackson Dr. A. S. Nichols Sylva.
Johnston Dr. A. H. Rose Smithfield.
Jones Dr. A. F. Hammond Pollocksville.
Lee Dr. J. P. Monroe Sanford.
Lenoir Dr. N. A. Whitaker Kinston.
Lincoln Dr. J. W. Saine Lincolnton.
McDowell Dr. Guy S. Kirby Marion.
Macon Dr. S. H. Lyle Franklin.
Madison Dr. W. J. Weaver Marshall.
Martin Dr. W. E. Warren Williamston.
Mecklenburg Dr. C. S. McLaughlin Charlotte.
Mitchell Dr. V. E. Butt Bakersville.
Montgomery Dr. C. Daligny Troy.
Moore Dr. Gilbert McLeod Carthage.
Nash Dr. J. P. Battle Nashville.
New Hanover Dr. W. D. McMillan Wilmington.
Northampton Dr. H. W. Lewis Jackson.
Onslow Dr. Cyrus Thompson Jacksonville.
Orange Dr. C. 0. Jones Hillsboro.
Pamlico Dr. D. A. Dees Bayboro.
Pasquotank Dr. H. T. Aydlett Elizabeth City.
Pender Dr. E. H. Bradford Burgaw.
Perquimans Dr. T. S. McMullen Hertford.
Person Dr. W. T. Long Eoxboro.
Pitt Dr. W. M. Fountain Greenville.
Polk Dr. Earl Grady Tryon.
Eandolph Dr. J. V. Hunter Asheboro.
Eichmond Dr. W. P. Webb Eockingham.
Eobeson Dr. W. A. McPhail Lumberton.
Eockingham Dr. Samuel Ellington Wentworth.
Eowan Dr. M. L. Smoot Salisbury.
Eutherford Dr. E. B. Harris Eutherfordton.
Sampson Dr. A. M. Cooper Clinton.
Scotland Dr. Peter McLean Laurinburg.
Stanly Dr. J. F. Laton Albemarle.
Stokes Dr. J. W. Xeal Walnut Cove.
Surry Dr. J. E. Woltz Dobson.
Swain Dr. A. M. Bennett Bryson City.
Transylvania Dr. Goode Cheatham Brevard.
Tyrrell Dr. J. L. Spruill Columbia.
Union Dr. H. D. Stuart Monroe.
Vance Dr. E. F. Fenner Henderson.
Wake Dr. J. J. L. McCullers McCullers.
Warren Dr. M. P. Perry Macon.
Washington Dr. W. H. Ward Plymouth.
Watauga Dr. H. McD. Little Boone.
Wayne Dr. T. M. Bizzell Goldsboro.
Wilkes Dr. E. M. Hutchens North Wilkesboro.
Wilson Dr. W. S. Anderson Wilson.
Yadkin Dr. T. E. Harding Yadkinville.
Yancev Dr. W. B. Eobertson Burnsville.
Letter of Transmittal
JSTorth Carolina State Board of Health,
Office of the Secretary,
Raleigh, X. C, August 3, 1911.
His Excellency, W. W. Kitchen,
Governor of Xorth Carolina.
Sir:—Under the authority of Section 4137 of The Revisal of 1905, I
have the honor to submit the Biennial Report of the State Board of
Health for the years 1909 and 1910.
In making this report I desire to express the sincere appreciation of
the State Board of Health for your deep interest in the fundamental
question of public health, for the strong recommendation for the in-crease
in the State appropriation for this purpose contained in your
last message to the Legislature, and for your cordial co-operation un-stintedly
given at all times in assisting us in dealing with public health
situations of peculiar interest.
Very respectfully yours,
"W. S. Rankin,
Secretary and Treasurer.
Legislation by General Assembly of 1909
Chapter 389.
AN ACT TO PROVIDE DIPHTHERIA ANTITOXIN FOR INDIGENT
PERSONS SICK OF DIPHTHERIA.
The General Assembly of North Carolina do enact:
Section 1. That the North Carolina Board of Health is hereby authorized and
directed to arrange for a sufficient supply of diphtheria antitoxin for the treat-ment
therewith, free of charge, of indigent persons sick of diphtheria, and for
immunizing against infection such indigent persons as may be exposed to the dis-ease,
and to extend the facilities for making the diagnosis of the disease.
Sec. 2. That the said board of health shall keep on hand in the State Labora-tory
of Hygiene a supply of reliable diphtheria antitoxin, and shall distribute,
through the said laboratory, to the several counties of the State, whenever the
boards of county commissioners thereof shall request it, and shall notify the Sec-retary
of the State Board of Health that they will pay for the same upon presen-tation
of a bill, and shall designate the person or persons with whom it shall be
deposited. The antitoxin shall be furnished at the lowest figure obtainable for
a reliable preparation.
Sec. 3. That whenever a physician is called to a case of diphtheria in an indi-gent
person or one in immediate need and unable to pay for antitoxin, he may
obtain the same from one of the depositories or diphtheria stations by filling out
and signing in duplicate the blank requisition form to be supplied with the anti-toxin
by the said board of health, and presenting the same to the county superin-tendent
of health or any member of the county sanitary committee, or to such
person as the said county sanitary committee may appoint, who, after satisfying
himself as to the indigency of the person or persons for whom the antitoxin is
intended, shall approve and countersign in duplicate the requisition. The person
dispensing the antitoxin shall retain one copy of the requisition and shall mail
the duplicate promptly to the director of the laboratory of hygiene. He shall
also return to the said director all packages of antitoxin in his possession as soon
as they become out of date.
Sec. 4. The provisions of this act shall apply to cities and towns upon the same
conditions as it does to counties.
Sec. 5. That for carrying out the provisions of this act the sum of five' hundred
dollars annually is hereby appropriated.
Sec. 6. That this act shall be in force from and after its ratification.
Ratified this the 26th dav of Februarv, A. D. 1909.
Chapter 722.
AN ACT TO PROVIDE FOR THE REGISTRATION OF DEATHS IN MUNICI-PALITIES
OF ONE THOUSAND POPULATION AND OVER IN THE STATE
OF NORTH CAROLINA.
The General Assembly of North Carolina do enact:
Section 1. That all deaths that occur in cities or towns having a population
of one thousand or over by the last preceding federal census shall be registered
bv the clerks or other officials designated bv the board of aldermen or town com-
6 NORTH CAROLINA BOARD OF HEALTH.
missioners thereof, who are hereby constituted local registrars of deaths, within
three days after the occurrence of said deaths and before the bodies are removed,
interred or otherwise disposed of: Provided, that in cities or towns now having
satisfactory registration of deaths under their ordinances the health officer or
other official now acting as local registrar shall continue as such, but shall con-form
to the provisions of this act and to the regulations of the State Board of
Health adopted thereunder.
Sec. 2. That a certificate of death, of standard form, provided by the State
Board of Health, shall be filed with the local registrar by the undertaker or other
person in charge of the removal, interment or other disposal of the body of the
deceased person, and a permit shall be issued by said local registrar for such
removal, interment or other disposal of the body only after such certificate of the
cause of death, signed by the attending physician, or, in case there shall be no
attending physician, by the health officer, or, in case there is no health officer of
the city or town, by the local registrar, who shall give the medical cause of death,
as nearly as he can determine it, after full inquiry, in regard thereto, of the
householder in whose family the death occurred: Provided, that under no circum-stances
shall the local registrar sign the death certificate when there has been an
attending physician or there is a municipal health officer. No sexton or superin-tendent
of a cemetery in cities and towns having a population of one thousand
or over shall permit interment, and no railway company or other common carrier
shall transport a body of a deceased person whose death occurred in this State
unless accompanied by the local registrar's permit.
Sec. 3. That the local registrar shall number each certificate as received, record
it in a local register of deaths, and promptly by the fifth day of the following
calendar month send all of the original certificates to the secretary of the State
Board of Health, at Raleigh, who is hereby constituted State Registrar of Vital
Statistics. The said registrar, with the approval of the State Board of Health,
shall maintain in his office a bureau of vital statistics, preserve, index and com-pile
the original returns, and make copies thereof for legal or other purposes, as
may be necessary, which copies, when officially certificated, shall be prima facie
evidence of the facts therein set forth, in all the courts of the State, for all pur-poses
of this act. The State registrar shall prepare and distribute all blanks and
instructions necessary for the execution of this act, and shall see that the pro-visions
of this act are faithfully enforced; and the solicitors of the several dis-tricts
and the Attorney-General shall aid him, upon his request, and enforce the
penalty of the law, in case of its violation. Each of the said local registrars
shall be entitled to a fee of twenty-five cents for his service, under this section,
to be paid by the city or town.
Sec. 4. That any undertaker, sexton or superintendent of a cemetery, agent of
a transportation company, local registrar or other person who violates the pro-visions
of this act, and any attending physician who fails or neglects to certify
to the cause of death when the certificate is presented to him for the purpose, and
every local registrar who shall neglect to perform any of the duties required of
him by section three of this act shall be guilty of a misdemeanor, and upon con-viction
thereof shall be liable to a fine of not less than five nor more than fifty
dollars or imprisonment for not less than ten nor more than thirty days, and shall
also be liable to a penalty of twenty-five dollars in favor of any person who shall
sue for the same.
Sec. 5. The mayor of each city or town of one thousand or more inhabitants
THIRTEENTH BIENNIAL REPORT. 7
shall be responsible for the enforcement of this act in his jurisdiction. Failure on
his part to so enforce its provisions shall be a misdemeanor, and he shall be
liable to a fine of not less than ten nor more than fifty dollars; and it shall be
the duty of the solicitor of the judicial district in which the city or town is
situate, upon complaint of the State registrar or of the secretary of the State
Board of Health, to institute a criminal action for the enforcement of said fine.
Sec. 6. That this act shall be in force from and after its ratification.
Ratified this the 6th day of March, A. D. 1909.
Chapter 793.
AN ACT TO AMEND SECTIONS 3045, 3058, 3457, 4440, 4442, 4444, 4457, 44G0
AND 4508 OF THE REVISAL OF 1905, RELATING TO THE PUBLIC
HEALTH.
The General Assembly of North Carolina do enact:
Section 1. That section three thousand and forty-five of The Revisal of one
thousand nine hundred and five be amended by inserting after the word "method,"
in line twenty-eight, the words "scope and detail," and by adding at the end of
said section three thousand and forty-five the following: "Full reports, in dupli-cate,
of all such inspections shall be made promptly to the secretary of the State
Board of Health and their accuracy certified by the affidavit of the inspector or
such officer or person as the said secretary may direct."
Sec. 2. That section three thousand and fifty-eight of said Revisal be amended
by adding thereto, as subsections (a), (b) and (c), the following:
"(a) The State Board of Health shall have the general care and oversight of
all inland waters, and shall, from time to time, as it may deem advisable, cause
examinations of said waters and their sources and surroundings to be made, for
the purpose of ascertaining whether the same are adapted for use as water sup-plies
for drinking and other domestic purposes or are in a condition likely to
impair the interests of the public or of persons lawfully using the same, or to
imperil the public health. For the purpose aforesaid it may employ such expert
assistance as may be necessary. The said board shall make such rules and regu-lations
as in its judgment may be necessary to prevent contamination and to
secure such purification as may be required to safeguard the public health. Any
individual, firm, corporation or municipality, or the person or persons responsible
for the management of the water supply, failing to comply with said rules and
regulations shall be guilty of a misdemeanor, and upon conviction shall be fined
or imprisoned, or both, at the discretion of the court.
"(6) The said board shall from time to time consult with and advise the boards
of directors of all State institutions, the authorities of cities and towns, corpora-tions
or firms already having or intending to introduce systems of water supply,
drainage or sewerage as to the most appropriate source of supply, the best prac-tical
method of assuring the purity thereof or disposing of their drainage or
sewage, having regard to the present and prospective needs and interests of other
cities, towns, corporations or firms which may be affected thereby. All such
boards of directors, authorities, corporations and firms are hereby required to give
notice to said boards of their intentions in the premises, and to submit for its
advice outlines of their proposed plans or schemes in relation to water supply and
8 NORTH CAROLINA BOARD OF HEALTH.
disposal of sewage; and no contract shall be entered into by any State institu-tion,
city or town for the introduction of a system of water supply or sewage
disposal until said advice shall have been received, considered and approved by
said board. Violation of the provisions of this subsection (5) shall be a misde-meanor,
and upon conviction those responsible therefor by neglect of duty shall
be fined not less than fifty dollars nor more than two hundred dollars, at the dis-cretion
of the court.
"(c) That for the purpose of carrying out the general provisions of the said
section three thousand and fifty-eight, as set forth in subsections (a) and (6),
every municipal or private corporation, company or individual supplying or au-thorized
to supply water for drinking or other domestic purposes to the public
shall file with the secretary of the State Board of Health, within ninety days
after receipt of notice from said secretary, certified plans and surveys, in dupli-cate,
pertaining to the source from which the water is derived, the possible sources
of infection thereof, and the means in use for the purification thereof, in accord-ance
with the directions to be furnished by the said secretary. Failure to file
said plans and surveys, as required in this subsection (c), shall be a misde-meanor,
and upon conviction those responsible therefor by neglect of duty imposed
thereby shall be fined not less than fifty nor more than one hundred dollars, at
the discretion of the court ; and every delay of one calendar month after the expi-ration
of the said ninety days shall be a separate offense."
Sec. 3. That section three thousand four hundred and fifty-seven of said Re-visal
be amended by adding thereto as subsection (a) the following:
"(a) That for any violation of this section or of the laws relating in any way
to the public health it shall be the duty of the solicitors of the several judicial
districts, upon complaint of the board of health, or of any of its officers, or of
any individual injured or likely to be injured, to institute a criminal action
against the person, firm, corporation or municipality charged with such violation
in their respective districts, and prosecute the same."
Sec. 4. That section four thousand four hundred and forty of said Revisal be
amended by striking out all after the heading and substituting in lieu thereof the
following: "The State Board of Health shall have a president, a secretary (who
shall also be treasurer) and an executive committee, said executive committee to
have such powers and duties as may be assigned it by the board of health. The
president shall be elected from the members of the board and shall serve six
years. The secretary-treasurer shall be elected from the registered physicians of
the State and shall serve six years. The executive committee shall be composed
of the president and the engineer member of the board, ex officio, and one other
member of the board, to be elected from those composing it. The executive office
of the board shall be in the city of Raleigh and the secretary shall reside there.
The secretary shall be the executive officer of the board, and shall, under its
direction, devote his entire time to public health work and shall be known as the
State Health Officer. He shall receive for his services such yearly compensation
as shall be fixed by the board, not to exceed three thousand dollars and his actual
traveling and hotel expenses when engaged in the work of the board. The board
may in its discretion elect as a special assistant to the State Health Officer, for
the anti-tuberculosis work, the Secretary of the State Association for the Preven-tion
of Tuberculosis, at an annual salary not to exceed six hundred dollars. The
members of the board shall receive no pay, except that each member shall receive
four dollars a day and necessary traveling and hotel expenses when on actual duty
THIRTEENTH BIENNIAL REPORT. 9
in attending the meetings of the board or of the executive committee or in pursu-ing
special investigations in the State; but when attending important sanitary
meetings beyond the limits of the State, the number of delegates thereto being
limited to one, in addition to the secretary, only actual traveling and hotel ex-penses
shall be allowed. These sums shall be paid by the treasurer on authenti-cated
requisition, approved and signed by the president."
Sec. 5. That section four thousand four hundred and forty-two of said Eevisal
be amended by adding thereto the following: "The executive committee shall meet
at such time as the president of the board may deem necessary, and he shall call
such meetings through the secretary."
Sec. 6. That section four thousand four hundred and forty-four of said Revisal
be amended by adding thereto the following: "Provided, that if the sanitary
committee of any county shall fail to elect a county superintendent of health with-in
two calendar months after the time set in section four thousand four hundred
and forty-one of said Eevisal for such election, the State Board of Health shall
appoint a registered physician of good standing, resident in the said county, who
shall serve the remainder of the regular two-year term, and shall fix his compen-sation,
to be paid by the said county, in proportion to the salaries paid by other
counties for the same service, having in view the amount of taxes collected by the
said county."
Sec. 7. That section four thousand four hundred and fifty-seven of said Revisal
be amended by striking out, in line two, the word "two" and inserting in lieu
thereof the word "six."
Sec. 8. That section four thousand four hundred and sixty of said Eevisal be
amended by adding thereto as subsection (a) the following:
"(a) Any householder in whose family there is to his knowledge a person sick
of cholera or typhoid fever, who shall permit the bowel discharges of such
sick person to be emptied without first having disinfected them according to in-structions
to be obtained from the attending physician or the county superintend-ent
of health, shall be guilty of a misdemeanor, and upon conviction shall be fined
not less than two nor more than twenty-five dollars or imprisoned not less than
ten nor more than thirty days. In cases where such undisinfected discharges are
emptied on the watershed of any stream or pond furnishing the source of water
supply for any public institution, city or town, the penalty shall be a fine of not
less than twenty-five nor more than fifty dollars or imprisonment for not more
than thirty days. And any physician attending a case of cholera or typhoid fever
who refuses or neglects to give the proper instructions for such disinfection as
soon as the diagnosis is made shall be deemed guilty of a misdemeanor, and upon
conviction shall be fined not less than ten nor more than fifty dollars."
Sec. 9. That section four thousand five hundred and eight of said Eevisal be
amended by inserting after the word "mention," in line eight, the words "or of
tuberculosis or typhoid fever."
Sec. 10. That this act shall be in force from and after its ratification.
Ratified this the 8th day of March, A. D. 1909.
10 NORTH CAROLINA BOARD OF HEALTH.
CHANGES IN PERSONNEL OF BOARD.
In amending section 4440 of The Eevisal of 1905 the General Assem-bly
of 1909 greatly benefited the cause of public health. This amend-ment
increased the appropriation for the Board from $2,000 to $6,000,
thereby, making it possible to further amend this section by requiring
the entire time of the executive officer of the Board to be devoted to the
public health work of the State.
In securing the favorable consideration of the General Assembly for
this extension of the work of the Board, former Secretary Dr. Richard
II. Lewis was chiefly instrumental. The act, by requiring the entire
time of the Secretary, made it necessary for the father of the bill to
culminate seventeen years of patriotic devotion to the State's greatest
asset, the health of her people, in his own official self-sacrifice. Along the
trail that this pioneer sanitarian blazed through discouragement, super-stition
and incredulity, his followers will endeavor to propel, with the
force of public opinion awakened to its civic obligations in the pre-vention
of unnecessary death, the life saving legislation of the future.
On March 30, 1909^ the State Board of Health met in a called meet-ing
in the office of the Secretary, at Raleigh. Dr. Lewis then explained
the amended law which required the executive officer to devote his
entire time to the work of the Board. After stating that he could not
afford to surrender his practice, he tendered his resignation as Secre-tary.
The Board, after insisting in vain upon the withdrawal of the
resignation, reluctantly accepted it. Dr. W. S. Rankin, of Wake For-est,
was elected to succeed Dr. Lewis. The present incumbent took
charge of his duties July 1, 1909.
Another change in the personnel of the Board was caused by the
untimely death of Dr. James A. Burroughs, of Asheville, on December
28, 1909. Dr. James E. Ashcraft, of Monroe, Avas elected by the Board
at Wrightsville on June 22, 1909, to fill the vacancy made by the death
of Dr. Burroughs. Colonel J. L. Ludlow, of Winston-Salem, whose
term of office expired in May, 1909, Avas reappointed by the Governor.
POLICY AND DUTIES OF STATE BOARD OF HEALTH.
In pursuance of the policy inaugurated by his predecessor, the present
Secretary has recognized the functions of the Board of Health as execu-tive
and advisory or educational. Of the two duties the last is of first
importance. Even the enactment of law, and much more the execution
of law, is dependent upon an approving public sentiment, and public
sentiment is the direct offspring of education. The Earl of Derby was
therefore correct in saying, "Sanitary instruction is even more im-portant
than sanitary legislation."
With the great amount of indifference to the enforcement of sanitary
laws on the part of the people, public health education, carried on
through all available agencies, press, special literature and platform, is
the most urgent, important and gigantic task of the Board. Neverthe-
THIRTEENTH BIENNIAL REPORT. 11
less, the will of the people as expressed through their representatives
makes the executive duties of the Board mandatory, and for this reason
they will be first considered.
Executive Functions of Boards of Health.
DIFFERENCE IN PRINCIPLE OF STATE AND LOCAL HEALTH LAWS.
The executive function of the State Board of Health consists in see-ing
to the enforcement of all State health laws, with the exception of the
Food and Drug Act. Health laws are and always will be divisible into
State and local laws—municipal and county health laws.
State health laws should control all those conditions affecting the
public health that are not limited to the jurisdiction of counties; that
is, that are inter rather than mira-county concerns. Those conditions
that affect the public health and that conform to this principle are
sanitary control of watersheds, the law requiring the registration of
deaths, the sanitary supervision of State institutions and the enforce-ment
of quarantine.
The reasons for this are perfectly clear. The only available water
supply of a town may be taken from a river that flows through another
county before reaching the one in which the town supplied is located.
Under such conditions, the necessary, just and only protection of the
purity of such water supply must be furnished by the State. The same
thing holds true for the law requiring the registration of deaths. If
each county had its own system of death registration, there would be
no uniformity, and, for comparison (and this is the only value of sta-tistics),
the records would be almost worthless. The sanitary super-vision
of State institutions that care for the afflicted and criminal, not
of one county but of the entire State, should be, as it is, under State
control.
A GRAVE DEFECT IN THE STATE HEALTH LAWS.
Contagion is no respecter of county boundaries, and the law controll-ing
the prevalence of contagious diseases should be enforceable through
State officials. Right here is one of the most serious defects in the
health laws of our State. At present quarantine, that is, the control
of contagious diseases, is entirely within the jurisdiction of the county
superintendent of health. An inefficient county superintendent of
health, elected and retained in office by a responsible board of county
commissioners, may neglect or refuse to quarantine or disinfect until an
epidemic in his county spreads and involves other contiguous and even
distant counties. In this way it is in the power of a board of county
commissioners to permit their county to become a hotbed for the dis-semination
of disease, a public nuisance, and an expensive neighbor to
sister counties and even other States. Under such conditions the State
at present is powerless. A large number of appeals from county super-intendents
of health to the secretary of the State Board of Health ask-ing
protection for their counties against contagion turned loose through
ignorance, indifference, or deliberate political play of moral weakness
to ignorant popular favor, are now on file in the office of the secretary.
12 NORTH CAROLINA BOARD OF HEALTH.
\
To these appeals we were, under our present quarantine law, debarred
from extending the necessary assistance.
A bill will be introduced in the present General Assembly to give the
State authority to enforce the quarantine laws, making it possible
thereby to protect the majority of intelligent, health-loving counties
from a few county health governments remarkable for lax quarantine
enforcement.
PRESENT STATE HEALTH LAWS.
The present enforceable State health laws are : The law requiring
the registration of deaths in towns or cities with a population of 1,000
or over, according to the last decennial census; the law relating to the
inspection of State institutions ; the law requiring the distribution of
diphtheria antitoxin to the indigent sick of diphtheria ; the law requir-ing
the appointment of a county superintendent of health when this
duty is not performed by the county sanitary committee; the law per-taining
to the sanitary control of public water supplies and the law
governing the work of the State Laboratory of Hygiene.
THE VITAL STATISTICS LAW.
To the health officer vital statistics are what the chart and compass
are to the mariner. Without them he knows not whence he came nor
whither he goes.
By vital statistics he is warned against danger. A timely warning,
an opportune application of the ounce of prevention, and many lives
are saved. For example, the vital statistics of a certain town show that
that town has twice the average death rate of other towns in which the
same climatic conditions prevail. This fact, but for these statistics,
would escape notice, for people die slowly, and neighbors, without some
comparative record, would regard their deaths as natural. An inves-tigation
follows the disclosure of these statistics, and the cause of this
increased death rate is discovered ; the cause is then removed and proper
precautions are taken to prevent its continued morbid effect and the
loss of many lives is prevented.
By vital statistics the health officer's course—progression or retro-gression—
is both indicated and measured. Some measure of supposed
sanitary value is put into operation. Its value will be measured almost
wholly by the statistical returns. If it is without effect, the cost of
operating it will be saved; if it is life-saving, others may know and
take advantage of it.
By vital statistics justice often finds her way clear and travels
quickly, whereas, without them, she creeps along with difficulty or loses
altogether the indistinct trail of the murderer, abortionist, or suicide.
Without them the child labor law is often administered by an ignorant
or cruel parent. ~No birth registration, no efficient child labor laws.
Our vital statistics law, chapter 722, Laws of 1909, pronounced by
Chief Statistician Wilbur, of the United States Bureau of the Census,
to be the only practical vital statistics law in the South, has been in
operation since September, 1909. This authority and government ex-pert
on the enforcement of vital statistics laws made an inspection of
THIRTEENTH BIENNIAL REPORT. 13
the results of the enforcement of our vital statistics law through a per-sonal
visit and examination of the certificates filed in the office at
Raleigh, in the early part of April, 1910. It is encouraging to those
of us concerned in its execution to know that he was well pleased with
its enforcement. The approval of the execution of this law encour-ages
us to hope that North Carolina will at an early date he accepted
by the Federal Government as a registration State.
At present our vital statistics law applies only to cities and towns
with a population of 1,000 or over, according to the last decennial
census. This gives us a registration area containing about 450,000
people, or about one-fifth of our State's population.
THE LAW GOVERNING SANITARY INSPECTION OF STATE INSTITUTIONS.
This law has been faithfully executed. In every instance the inspec-tion
was made without previous notification, and the conditions found
may therefore be regarded as a fair index to the everyday conditions
obtaining in our State institutions. The official report of these inspec-tions
will be found on pages 85-92 of this report.
THE LAW REQUIRING THE DISTRIBUTION OF DIPHTHERIA ANTITOXIN.
In accordance with this act, passed by the Legislature of 1909, 67
counties and 8 cities have availed themselves of the opportunity of
obtaining antitoxin at a very reduced rate for their poor. The State
Laboratory of Hgyiene acts as a distributing depot, and ships the
antitoxin, on demand, to any point in the State. By the contract with
the manufacturers, the special rate can be obtained only for indigent
cases when paid for by the county or municipality. The benefits of the
act do not apply to that largest class of the population, the independent
poor, those who do not want to be classed with the indigent, yet can ill
afford to pay the high prices charged for diphtheria antitoxin. It is
therefore recommended that the General Assembly be requested to fur-nish
diphtheria antitoxin to its citizens free of charge or at least ar-range
to furnish it to all its citizens at actual cost. It is possible that
the latter arrangement could be made without a change in the law, and
it is recommended that a new contract be sought with this in view. It
may be desirable ultimately for the State to manufacture its own anti-toxin,
but meanwhile the same good can be accomplished at approxi-mately
the same cost if the General Assembly sees fit to buy all the anti-toxin
needed for its citizens.
A bill will be introduced in the next legislature asking for a change
in this law.
THE LAW REQUIRING THE APPOINTMENT OF A COUNTY SUPERINTENDENT
OF HEALTH.
The proviso in Section 4444, Revisal of 1905, as amended by the
General Assembly of 1909, authorizes the Secretary of the State Board
of Health to appoint a county superintendent of health in counties
where the sanitary committee have failed to elect that official. In only
one instance has it been necessary for the secretary to comply with this
proviso of the law during the last two years.
14 NORTH CAROLINA BOARD OF HEALTH.
THE LAWS RELATING TO THE PUBLIC WATER SUPPLY.
The laws governing the protection of public water supplies against
pollution requires the filing in duplicate by the superintendent of the
water company of certified plans and surveys of the watershed made in
accordance with instructions furnished by the State Board of Health.
These instructions are embodied in "Circular A," an exact copy of which
is reproduced on page 98 of this report.
The law protecting the public water supplies against pollution further
requires that a quarterly inspection and report of the sanitary condi-tion
of the watershed and all surface supplies be made in accordance
with reasonable rules and regulations of the State Board of Health.
In accordance with these rules and regulations the sanitary inspectors
of the different surface supplies are furnished with instructions for
making the inspection. These instructions are embodied in "Circular
B," an exact copy of which is reproduced on page 101 of this report.
In making the inspection of a watershed the inspector leaves at each
home a copy of "Circular C," which instructs the householder and family
in regard to their duties in the protection of the public water supply
through the proper sanitary care of their premises. This circular is
reproduced on page 108 of this report.
Finally, the inspector after having made his inspection in accordance
with "Circular A," and after having instructed the residents on the
watershed in accordance with "Circular C," makes out his report in
duplicate on "Form A," an exact copy of which is reproduced on page
110 of this report, and then mails these reports to the Secretary of the
State Board of Health.
In connection with the sanitary supervision of the public water sup-plies,
I feel that as the State health officer I should violate both my
sense of duty and my public trust if I failed to make grateful acknowl-edgment
of the cordial, untiring and almost unlimited assistance ren-dered
me in my efforts to protect the public water supplies by Colonel
J. L. Ludlow, of the State Board of Health. His able service has been
given so unstintedly to the public water supply interests that I feel that
it is a considerable imposition on the part of the State to accept these
services further without some material compensation.
The sanitary patrol and inspection of watersheds for the purpose of
preventing water-borne disease is reinforced in its purpose by the law
requiring monthly analyses of the various public water supplies. It
has never yet been necessary to apply to the courts to enforce the law
requiring water companies to send samples of their water monthly for
analysis, but the penalty for the enforcement of this law is so small
that Ave hope the General Assembly of 1911 will see fit to increase it.
Analyses to the number of 14,826 have been made in accordance with
this law from January 1, 1909, to December 31, 1910.
The law protecting public water supplies also applies to springs from
which water is sold either at summer or health resorts or in bottles. This
law requires that these springs shall pay a graduated tax or procure a
license, through which revenue the State Laboratory of Hygiene shall
be able to analyze the waters of these springs. The law further pro-
THIRTEENTH BIENNIAL REPORT. 15
vides that if any bottled water be found polluted in three successive
analyses, publication of that fact shall be made in the Monthly Bul-letin
of the State Board of Health. Very little trouble has been
experienced in the enforcement of this law. During the last two years
three bottled waters have been found polluted, and notice thereof given
to the public through the Bulletin.
Here I wish to call attention to the wide and beneficent scope of this
law. Those placing bottled waters on the market, knowing that sooner
or later some of the water will find its way into the State Laboratory
of Hygiene and there be analyzed, realize that if it is found polluted
and published through the Monthly Bulletin of the State Board of
Health, not only to the people of ISTorth Carolina but throughout the
United States, their business will be seriously injured. In this way this
law has a splendid influence in keeping commercial waters pure, not
only at the springs and bottling plants in North Carolina, but also
throughout the United States.
THE LAW ESTABLISHING THE STATE LABORATORY OF HYGIENE.
This law, Section 3057 of The Bevisal of 1905 as amended by the
Legislature of 1909, finds ample justification in the following detailed
statement
:
NUMBER OF SPECIMENS EXAMINED AT THE NORTH CAROLINA STATE LABORA-TORY
OF HYGIENE FROM MARCH 1908 TO DECEMBER 31, 1910.
1908
January
February
March. 62
April 104
May 114
June 141
July 183
August 227
September 271
October 201
November 171
December 189
1909
16 NORTH CAROLINA BOARD OF HEALTH.
Mississippi has just opened a laboratory, while Texas, Arkansas, Ken-tucky,
and Tennessee have no organized laboratories for work of this
character.
The direct appropriation to the Laboratory by the Legislature is
$2,000. The tax on water companies is approximately $4,000, thus
making the income of the laboratory $6,000. Eleven thousand six hun-dred
and forty-four different specimens were examined. The cost to the
State of each examination made in 1910 was 51 1-2 cents. Among the
specimens examined were 1,835 water analyses, each of which comprises
from five to twenty-five distinct chemical and bacteriological tests. If
each of these were estimated as separate tests the average cost would be
greatly reduced. Out of the above sum also 160 patients were given
the Pasteur anti-rabies treatment, as no appropriation is made for this
work.
OPINIONS OF ATTORNEY-GENERAL.
In executing the State public health laws it has frequently been
necessary to ask the advice of the Attorney-General. That official has
always given us the most cordial co-operation and it is impossible to
overstate our deep appreciation for his valuable opinions. A copy of
these opinions will be found on pages 68-84 of this report.
EDUCATIONAL FUNCTIONS OF THE STATE BOARD OF HEALTH.
Section 4437 of The Revisal of 1905 as amended by the General As-sembly
of 1909 reads as follows:
"The Board of Health shall take cognizance of the health interests of the people
of the State; shall make sanitary investigations and inquiries in respect to the
people, employing experts when necessary; shall investigate the causes of dis-ease
dangerous to the public health, especially epidemics, the sources of mortality,
the effect of locations, employments and conditions upon the public health. They
shall gather such information upon all these matters for distribution among the
people, with the especial purpose of informing them about preventable diseases."
The italics are ours.
This educational provision for the improvement of public health is a
most wise one. Out of education comes public sentiment ; through pub-lic
sentiment, law is both enacted and enforced. At present ninety per
cent of the work of the Board is of an educational nature. This work
has been carried on through the Bulletin of the State Board of
Health, through contributions to the newspapers, and through public
addresses.
THE BULLETIN.
The Bulletin has grown in circulation from 3,500 in January, 1910,
to 18,000 January, 1911, and with this increased circulation the size of
the Bulletin has been enlarged from a ten page to a seventy page pub-lication.
During the past four months, requests for the Bulletin have
averaged thirty-five daily. At present the entire ministerial, legal and
medical profession, about seven thousand out of the ten thousand school
teachers, and a large number of other wide-awake people throughout
the State receive this educational monthly.
THIRTEENTH BIENNIAL REPORT. 17
To give a wider field of usefulness to the Bulletin, a contributory
Board of Editors composed of the following gentlemen, have agreed to
assist in its publication
:
1. Governor W. W. KITCHIN, Raleigh, N. C.
2. Hon. A. H. ELLER, Winston-Salem, N. C.
3. Hon. E. W. SIKES, Wake Forest, N. C.
4. Hon. W. C. DOWD, Charlotte, N. C.
5. Mr. CLARENCE POE, Raleigh, N. C.
6. Mr. ARCHIBALD JOHNSON, Thomasville, N. C.
7. Rev. GEORGE W. LAY, Raleigh, N. C.
8. Dr. HENRY L. SMITH, Davidson, N. C.
9. Dr. FRANCIS P. VENABLE, Chapel Hill, N. C.
10. Dr. W. P. FEW, Durham, N, C.
11. Dr. WILLIAM L. POTEAT, Wake Forest, N. C.
12. Dr. F. L. STEVENS, West Raleigh, N. C.
13. Dr. CYRUS THOMPSON, Jacksonville, N. C.
14. Dr. CHAS. O'H. LAUGHINGHOUSE, Greenville, N. C.
15. Dr. L. B. McBRAYER, Asheville, N. C.
16. Dr. BENJ. K. HAYS, Oxford, N. C.
17. Dr. EDWARD J. WOOD, Wilmington, N. C.
18. Dr. WILLIAM DeB. MacNIDER, Chapel Hill, N. C.
19. Dr. H. A. ROYSTER, Raleigh, N. C.
20. Dr. J. L. NICHOLSON, Richlands, N. C.
This means that the Bulletin through a greater variety of expres-sion
and subject matter will be more attractive and more serviceable
than ever before. It, of course, would be impossible without great ex-pense
to republish the entire issues of the Bulletin during the past
two years in this report.
THE STATE PRESS.
The press of the State has been most cordial in its co-operation with
the Board for better public health. Always liberal in the use of their
columns for the public service, they have, in the assistance given us, even
exceeded their own enviable reputaton for generosity.
The State press in calling repeated attention to the fact that the Bul-letin
could be had for the asking, and that it was well worth a place
in the homes of our people, have had much to do with building up a
greater demand for that publication. During the months of July, Au-gust,
September, and October many of the papers of the State pub-lished
weekly articles on public health sent out from this office. To
conclude, the assistance of the press has been of inestimable value.
ADDRESSES.
During the last twelve months a number of public health addresses
—
fifty or sixty—have been delivered to audiences representing different
fields of activity. The Conferences of County Superintendents of
Schools for 1909 and 1910, the North Carolina Teachers' Assembly, the
North Carolina State Primary Teachers' Association, the Meeting of
Conductors of Teachers' Institutes, a number of Teachers' Institutes,
18 NORTH CAROLINA BOARD OF HEALTH.
the North Carolina Press Association, the Tri-State Medical Society,
the Wake County Medical Society, the Guilford County Medical So-ciety,
the North Carolina Society for the Study and Prevention of
Tuberculosis, the Carolina Municipal Association, the State Federation
of Women's Clubs, and many other gatherings of people have been ad-dressed
on the fundamental problem of public health. Through the
interest aroused in these various oganizations others have taken up the
study of public health problems and these have succeeded in interesting
many others.
THE ANTI-HOOKWORM CRLSADE.
Under the able direction of Assistant Secretary Dr. John A. Ferrell,
the public have been seriously and actively interested in a general cam-paign
against a disease the frequency of which probably totals all other
diseases combined.
Dr. Ferrell's report of the work accomplished is given in detail on
page 93 and a very superficial perusal of this report will warrant the
assertion that the work could not be in better hands.
THIRTEENTH BIENNIAL REPORT. 19
Meetings of the Board
Office of the Secretary,
Kaleigh, ]ST. C, March 30, 1909.
Called meeting. All the members of the Board present. The Presi-dent
called upon the Secretary to explain the object of the meeting. In
response he stated that the principal reason for calling the meeting was
that such action might be taken by the Board as was rendered necessary
by the amendment to the laws relating to the public health enacted at
the recent session of the General Assembly. For the information of the
Board the Secretary then read the four acts relating to the public health,
the titles of which were as follows
:
An Act to Amend Sections 3045, 3058, 3457, 4440, 4442, 4444, 4457, 4460 and
4508 of The Revisal of 1905, Relating to the Public Health.
An Act to Amend Section 3057 of The Revisal of 1905, relating to the State
Laboratory of Hygiene.
An Act to Provide for the Registration of Deaths in Municipalities of One
Thousand Population and Over in the State of North Carolina.
An Act to Provide Diphtheria Antitoxin for Indigent Persons Sick of Diph-theria.
He also called attention to the fact that the annual appropriation for
the support of the State Sanatorium for Tuberculosis had been in-creased
by the Legislature from $5,000 to $7,500, and that an additional
appropriation for permanent improvements of $15,000 a year for two
years had also been made.
Dr. Lewis then offered his resignation as Secretary and Treasurer, to
take effect June 30th, the last day of the month in which the fiscal year
ended. He gave as his principal reason for taking such a step the fact
that the new law required the Secretary to devote his entire time to
the cause of the public health and that he was unwilling to abandon his
regular profession—his life work. He expressed his regret at giving
up the work which had been for so many years largely a labor of love,
but felt sure that it was best both for the work's sake and for his own.
He explained to the Board that for some years he had realized that the
great importance of the work demanded all the time of a competent
Secretary with ample assistance, and believing the time to be auspicious
for a forward movement, he had prepared a bill which if enacted into
law, while legislating himself out of office, would bring this about. He
also stated that believing the successful prosecution of the work to be
dependent upon the qualifications in several respects of the new Secre-tary
and that a mistake in the selection of the man would be a mis-fortune
hard to remedy he had gone over in his mind the medical men
of the State and assured himself that such a man was available and that
if elected he would accept the position, before he wrote the bill. Hav-ing
expressed his gratification at tho fact that he would still continue
a member of the Board and his sincere appreciation of the unvarying
20 NORTH CAROLINA BOARD OF HEALTH.
kindness, courtesy and cordial support of the Board during his in-cumbency
of nearly seventeen years, he retired from the meeting.
Minutes by Dr. Way, Secretary pro tern.
Dr. Lewis resigned to take effect June 30, 1909, retiring from the
hall. The President placed his resignation before the Board and asked
their pleasure. Dr. Register expressed his great appreciation of the
splendid work of seventeen years and his regard for Dr. Lewis and had
felt that if he (Dr. Lewis) could be induced to continue he would ask
him to do so. He wished his appreciation of Dr. Lewis's great work
be recorded. Dr. Anderson reciprocated fully the words of Dr. Register.
Dr. Spencer moved that a committee composed of Drs. Register and
Thomas be appointed to confer with Dr. Lewis and ask if he can re-consider
his resignation and serve out his full term. Carried. This
committee through Dr. Thomas reported that Dr. Lewis felt compelled
to consider his resignation as final. Dr. Thomas eulogized Dr. Lewis
as one of the notably few men he had ever known fitted for the work.
On motion of Dr. Burroughs seconded by Dr. Spencer, Dr. Lewis's
resignation was accepted.
Dr. Burroughs moved that a committee of three be appointed by the
President at his convenience to prepare resolutions expressive of ap-preciation
for the annual session of the Board in June. Carried.
Dr. Lewis, returning, resumed his duties as Secretary. The chair
announced that nominations for Secretary and Treasurer to fill the
vacancy were in order. Dr. Lewis, prefacing his remarks by the state-ment
that he felt that he ought to say that Dr. Way had been his first
choice as his successor and that upon the assurance of the doctor that
while he felt a deep interest in the work he could not afford to give up
his lucrative practice and comfortable home, he had worked for and
found another good man, placed in nomination Dr. Watson S. Rankin,
Dean of the Medical Department of Wake Forest College, at a salary
of $3,000 a year. He declared Dr. Rankin to be in his. opinion a man
of character, ability, energy, enthusiasm and possessed of the altruistic
spirit so helpful in work of this kind and admirably fitted for the
position. The nomination of Dr. Rankin was seconded by Drs. Bur-roughs,
Register and Way, and he was unanimously elected.
Action on the election of an Assistant Secretary for the anti-tuber-culosis
work was upon a motion of Dr. Way, postponed until the annual
meeting in June.
The Secretary called attention to the fact that under the new law
one member of the Board must be elected to complete with the Presi-dent
and the engineer ex officio, the Executive committee. On motion
of Dr. Way, Dr. Lewis was elected to serve on the Executive Com-mittee.
On motion, the salary of Dr. C. A. Shore, Director of the Laboratory
of Hygiene, was increased from $2,000 to $2,500 a year; that of Miss
Daisy Allen, Chemical Assistant, from $75 to $90 a month, and that of
Miss Mabel P. Massey, Stenographer, from $50 to $75 a month, it
being understood that she was to give her whole time to the work of
the Board. All increase in salary to take effect July 1, 1909.
THIRTEENTH BIENNIAL REPORT. 21
Dr. Way, representing the Board of Health of Waynesville, filed with
the Board plans for a public water supply which had been approved by
the sanitary engineer of the Board. The plans were approved.
On motion, the Board adjourned.
Bichard H. Lewis, Secretary.
Battery Park Hotel,
Ashevtlle, N". C, June 15, 1909.
The Board met in annual session in the room of the Secretary, with
President Thomas in the chair. Those present were Drs. Thomas,
Anderson, Way, Spencer, Register, Burroughs, Col. Ludlow and the
Secretary.
The minutes of the last annual meeting at Winston-Salem and of the
called meeting held at Raleigh, March 30, 1909, were read and ap-proved
after the correction of the latter by the insertion of the follow-ing
resolution which had inadvertently been omitted
:
"Resolved, That His Excellency the Governor be requested to reappoint Col.
J. L. Ludlow as the Engineer member of the Board."
Unanimously adopted.
Drs. Ray and Robertson, of Yancey County, appeared before the
Board at the request of the Chairman of the Board of Commissioners of
that County to request the appointment by the Board of Health of a
Superintendent of Health for that county, as the County Sanitary Com-mittee
had failed to elect one. As the two months required by the
statute before action could be taken by the State Board of Health had
not expired, the matter, upon the motion of Dr. Spencer, was referred
to the Executive Committee.
The Secretary having called attention to the expiration of the term of
Dr. Way as a member of the State Board of Embalming, he was re-elected
for the full term of five years.
Col. Ludlow called attention to the menace to the public water supply
of the town of Greenville by the discharge of raw sewage into Tar river
by the towns of Rocky Mount and Tarboro and offered the following
resolution
:
"Resolved, That the Secretary of the Board shall give notice to the municipal
authorities of the towns of Rocky Mount and Tarboro that Section 3051 of The
Revisal of 1905 must be immediately complied with; and further, that in the
event that said towns shall fail to provide and put into operation such sewage
purification plants as said law requires within six months from this date, the
Secretary of the Board is hereby instructed to take such legal steps as may be
necessary to secure a restraining order from the courts of the State enjoining
said towns from further discharge of raw sewage into Tar River and to take
such steps as may be necessary to secure the conviction and punishment of
either or both of said towns and the authorities thereof for committing a
misdemeanor as defined and provided for, in the said public health laws of the
State of North Carolina."
This resolution was adopted.
22 NORTH CAROLINA BOARD OF HEALTH.
Col. Ludlow then called attention to the menace to the Raleigh water
supply by the town of Cary and offered the following resolution
:
"Resolved, That the Secretary shall give notice to the municipal authorities of
the town of Cary that the provisions contained in Section 3052 of The Revisal
of 1905 must be fully complied with immediately; and further, in the event
said authorities shall fail to comply with said Section 3052 within three months
of this date the Secretary is hereby instructed to take such steps as may be
necessary to secure the conviction and punishment of said town authorities for
committing a misdemeanor, as provided in said Section 3052 and in Section 3060."
This resolution was adopted by the Board.
The Engineer of the Board likewise set forth the danger of the con-tamination
of the public water supply of the town of High Point and
offered the following resolution :
"Resolved, That the Secretary shall give notice to the General Manager and
the Division Superintendent of the Southern Railway Company that in compliance
with the provisions of the Public Health Laws of North Carolina and more par-ticularly
of Section 3049 of The Revisal of 1905, the said railway company is
instructed to issue orders, and to secure the enforcement thereof, that all water
closets on trains shall be locked and disused between the depot of High Point, in
Guilford County, and the bridge crossing Deep River; and further, that the
casting from trains of sweepings from cars, dining car refuse, or other garbage
shall not be permitted between said points where the said railway traverses the
watershed of the High Point public water supply; and further, should this in-struction
and said laws be violated, that the Secretary shall take such steps as
may be necessary to secure the conviction and punishment of the said railway
company and the officers thereof for committing a misdemeanor, as provided for
in the Public Health Laws of the State of North Carolina. And further, that
the Secretary shall give similar notice and take similar action in other cases
where railways traverse the watershed of any public water supply within the
State whenever the knowledge of such condition may be brought to his atten-tion."
After considerable discussion the following substitute for the above
resolution, suggested by the Secretary and offered by Dr. Anderson, was
adopted :
"Whereas, The Southern Railway runs across the watershed of the public water
supply of the town of High Point and for a considerable distance quite close to
the bank of the stream of supply and the impounding reservoir and,
"Whereas, There is danger of infection of the said public water supply by the
infections of the passengers ; therefore, be it
"Resolved, That in compliance with Section 3047 of The Revisal of 1905 the
Southern Railway Company be, and it is hereby requested to have all water
closets locked between High Point and Deep River bridge."
Dr. Way was elected the delegate to the next meeting of the American
Public Health Association at Richmond and Dr. Lewis to that of the
Conference of State and Provincial Boards of Health at Washington.
Upon motion, the Executive Committee was empowered to exercise all
THIRTEENTH BIENNIAL KEPOKT. 23
the powers of the Board of Health in the time between the meetings of
the Board.
The President appointed Dr. Spencer and Col. Ludlow a committee
to audit the accounts of the Treasurer.
Upon motion of the Secretary his successor, Dr. Rankin, was invited
tc sit with the Board and take part in the proceedings. Accepting the
invitation the doctor expressed his appreciation of the honor done him
by the Board in his election as Secretary and Treasurer to succeed the
present incumbent and pledged his faithful service. Upon his inquiry
as to whether the Board or an individual would be expected to buy books
for the library of the Board, expressing his willingness to make the pur-chases
himself, Dr. Way moved—and the motion was carried—that
the Secretary be authorized to purchase such books and subscribe to such
journals relating to the public health as in his judgment might be
needed and the available funds would permit.
Upon motion of the outgoing Secretary, who agreed to look after the
office during the absence of his successor, Dr. Rankin was authorized
and requested to spend a month in investigating the practical methods
pursued by the executive health officers of such States as he might select
and in visiting the United States Hygienic Laboratory and the Bureau
of the Census, his traveling and hotel expenses to be paid by the Board.
Upon motion the Board adjourned to meet in conjoint session with
the State Medical Society tomorroAv at noon.
Richard H. Lewis, Secretary.
Annual Session of the Board of Health.
Asheville, 1ST. C, June 16, 1909.
The Board reassembled at 3 p. m. with President Thomas in the chair
and all the members present except Drs. Burroughs and Taylor.
In compliance with the amended law the Secretary nominated Dr.
C. A. Julian, the Secretary of the North Carolina Association for the
Prevention of Tuberculosis, for the position of Assistant Secretary of
the Board for Tuberculosis at a salary of three hundred dollars a year.
Dr. C. A. Julian was duly elected.
Upon the statement of the Secretary that Drs. E. J. Wood and H.
Bellamy, of Wilmington, had expressed a willingness to do research
work in the study of pellagra under the auspices of the Board they were
appointed a commission to undertake it.
Upon motion of Dr. Spencer, the Treasurer was instructed to pay the
traveling and hotel expenses incurred by Dr. Lewis as delegate to the
meeting of the American Public Health Association at Winnipeg,
Manitoba.
Upon motion the President appointed Drs. Way and Register a com-mittee
to draft suitable resolutions in regard to the retirement of the
present Secretary.
The Auditing Committee reported that they had examined the ac-counts
and vouchers of the Treasurer and found them correct.
Upon motion the Board adjourned.
Richard H. Lewis, Secretary.
24 NORTH CAROLINA BOARD OF HEALTH.
In the transcription of the proceedings from the rough notes of the
meeting of the 15th a sheet was inadvertently overlooked until after the
above was signed. The part of the proceedings referred to were as
follows
:
Upon motion of Dr. Way it was ordered that the Monthly Bulletin
of the Board be enlarged in expense and scope and that its mailing list
be enlarged as much as practicable.
Upon motion of Dr. Way the Secretary was requested to furnish the
Secretary of the Wake Medical Society a copy of the proceedings of
the Board at its called meeting on March 30, 1909, and of this session
for publication in the transactions of that society.
Upon motion of Col. Ludlow the State Superintendent of Public In-struction
was requested to require in the public schools not less than a
five-minute period daily to be devoted to some subject bearing on health
and the Secretary was requested to furnish the teacher with serviceable
literature. Richard H. Lewis, Secretary.
Conjoint Session of the North Carolina Board of Health
with the Medical Society of the State of North Carolina.
President G. G. THOMAS, Chairman.
Asheville, N. C, June 16, 1909.
The meeting was called to order by Dr. Thomas, of Wilmington,
Chairman of the State Board of Health.
Dr. Thomas : "This conjoint session marks a period in the history
of the State Board of Health of North Carolina, which to us is very
significant. It is the end of the service of Dr. R. H. Lewis, for so long
the efficient Secretary.
"Following Dr. Wood, the pioneer of sanitation in North Carolina,
he took up the work with zeal and enthusiasm, which he has guided and
carried on by his wonderful judgment to its present high state. To Dr.
Lewis belongs the spread of sanitary knowledge in the State of North
Carolina, and the present influence of the Board of Health in the com-monwealth.
"All of you are aware that these steps towards the commanding posi-tion
it now holds have been slow and faltering, but the State at large
has come to realize the fact that the State Board of Health has done
good work for it, and its recognition, I think, is thoroughly voiced in
the action of the last Legislature, in largely increasing the fund for its
support, at the suggestion of our Secretary, Dr. Lewis—which is the
prime evidence of the confidence which has followed his work, which is
as well based upon the character of the man. He has gained not only
our confidence and respect, but that of the gentlemen who represent
the different constituencies throughout the State.
THIRTEENTH BIENNIAL REPORT. 25
"I say, then, when this good man feels that he must lay down this
work,—not because he is feeble or infirm ; I assure you of the contrary,
it is because he can not relinquish his active professional work to take
up the work of the State Board of Health exclusively,—it is time to
feel grateful for the work he has done for the State and for the medical
profession." (Applause.)
Report of the Secretary read by Dr. Lewis.
KEPORT OF THE SECRETARY, MAY 20, 1908, JUNE 11, 1909.
Your Secretary, in this, his last report, is much gratified at heing able to
say that his last year of service has witnessed the greatest advance of the cause
of preventive medicine in our State, in a like period of time, since the establish-ment
of the State Board of Health. For several years he has realized that,
owing to the exactions of his private professional work, .the time he could- give to
the work of the Board was entirely inadequate. He believed also, that, owing
to the very small salary allowed the secretary, on account of the meager appro-priation,
no one else could be expected to give more attention to it and make a
proper living, and so he waited before taking action until, in his judgment, the
outlook was favorable for an attempt at a forward movement. Upon the assem-bling
of the last Legislature the conditions, in his opinion, justified making a
trial for better things. Consequently, having found a man whom he believed to
be well qualified for the position and having obtained from him a positive prom-ise
to accept an election, if tendered him by the Board, your Secretary prepared
a bill, while incidentally legislating himself out of office, as he could not afford
to abandon his private practice, that would provide the means for work far in
advance of anything heretofore attempted for the public health. The essential
feature of the bill was an increase of the annual appropriation from two to ten
thousand dollars, authorizing the payment to the Secretary of a salary of three
thousand dollars a year and requiring him to give his entire time to public
health work. While the Legislature cut down the appropriation asked for to
six thousand dollars, it still left an increase of 200 per cent and a sum sufficient
to secure all the time of a competent secretary, the one thing absolutely essential
to any marked progress.
As you already know, the present incumbent, at a call meeting on March 30th
last, tendered his resignation, which was accepted, to take effect July 1st, and
Dr. Watson S. Rankin, Dean of the Medical School at Wake Forest College, was
unanimously elected as his successor.
The public health laws were also materially and advantageously amended in
many other respects, particularly those sections relating to the control of public
water supplies by the State Board of Health, in the preparation of which latter
amendments, invaluable aid was rendered by the engineer of the Board, Col.
J. L. Ludlow.
Section 3057 of The Revisal of 1905, relating to the State Laboratory of Hy-giene,
was amended by specifically requiring analyses of drinking waters sold in
bottles or other packages and imposing upon those selling them an annual tax
graduated in proportion to the gross receipts from sales. While the. original act
imposed an annual tax of $G4 upon all individuals, firms and corporations selling
water to the people, it was found, upon investigation, that in many instances this
was out of proportion to the business done, and it was deemed both right and
wise to make the tax equitable and at the same time to make it perfectly clear
26 NORTH CAROLINA BOARD OF HEALTH.
that bottled waters came within the law. The necessity for analysis of this
class of waters was startlingly shown by analyses your Secretary had made in
the laboratory in the genera] cause of the public health and for the purpose of
supplying ammunition with which to meet an attack upon the law, threatened by
the president of one of the companies selling a water of this class. Of sixty-one
samples from twenty-nine springs thirty-two were found to be infected with colon
bacilli. Although the gentleman referred to passed away before the General
Assembly met, the information thus obtained was of service in securing the de-sired
legislation. The section was further amended so as to require analyses of
the waters of springs "maintained and treated as an adjunct to any hotel, park
or resort for the accommodation or entertainment of the public," and an annual
tax of $15 was imposed upon all such sources of water supply, with an addi-tional
tax on all waters sold therefrom in bottles, in accordance with the schedule
referred to above.
Probably the weakest spot in our sanitary legislation has been the lack of
reliable vital statistics. The only statistics we have had heretofore have been
those collected by some twenty-odd cities and towns in various and manifestly,
in some instances, very imperfect ways, and incomplete and inaccurate vital
statistics are practically worthless. A model vital statistics bill for States was
sent us by both the Bureau of the Census and by the American Medical Asso-ciation.
Theoretically, it was an excellent bill, and for densely populated, highly
organized communities it is doubtless practicable, but for our State, with its
large, widely scattered rural population, and one-third of that negroes, it would
have been little short of absurd. After a very careful consideration of the sub-ject
it was decided that any attempt at the collection of reliable vital statistics
holding out the least hope of success, for the present at least, would have to be
limited to incorporated towns. So, desiring that our statistics might fit in with
those of the United States Census Bureau, a request was made of Dr. Cressy L.
Wilbur, Chief Statistician, to have prepared for us a bill applying only to cities
and towns of one thousand population and over. Taking the bill he kindly and
promptly sent as a basis, it was modified to fit our conditions. After its passage
in its completed state it was very gratifying to learn from Dr. Wilbur that it
was the first practical vital statistics law to be enacted in the South, and, more-over,
that it contained a provision for the enforcement, new to him and in his
opinion valuable. This provision was placing the responsibility for carrying
out the law solely upon the mayor, and making him liable to a fine of not less
than $10 for failure of duty in this respect: and at the same time making it
mandatory upon the solicitor to institute a criminal action for its collection,
upon complaint of the State Begistrar or Secretary of the State Board of Health.
It really looks now as if vital statistics of real value, though necessarily partial,
were in sight.
The high price of diphtheria antitoxin being prohibitory to the poor, the pro-priety
of making provision for its supply free to indigent cases of the disease
should not be questioned by any humane person. The suggestion of the advisa-bility
of such legislation came from Dr. B. E. Beeves, of Alleghany County, in
a letter, accompanied by a tentative bill, to Senator B. L. Doughton, of the same
county. The suggestion was cordially received, and at his request Dr. Beeves's
bill was modified and amplified into the law as we now have it.
Another forward step was the increase in the annual appropriation for the
support of the State Sanatorium for Tuberculosis, from $5,000 to $7,500, and the
THIRTEENTH BIENNIAL REPORT. 27
appropriation of $30,000 for improvements. This institution, which is ideally
located, was opened for patients in November last, and promises to be of much
value in the campaign against tuberculosis.
The most gratifying and encouraging thing in connection with the health legis-lation
by the late General Assembly is that, with the exception of the cutting
down of the appropriation of ten thousand dollars asked for to six and an imma-terial
amendment to the bill relating to the Laboratory of Hygiene, requiring
reciprocity in the matter of analyses of bottled waters with other States having
similar laboratories and requirements, all the bills relating to the public health
in any way were passed without amendment and without a single vote in the
negative. This signifies a remarkable growth in favorable public opinion and
justifies the hope of more rapid progress in the near future.
As this report is made to the conjoint session of the State Board of Health
with the Medical Society, and as nothing is of more importance to the public
health than well-qualified physicians, reference to the strictly medical legislation
is in order.
A bill, prepared by the Board of Medical Examiners, the essential feature of
which was the requirement of a preliminary education equal to graduation from
a high school of all applicants for license, was introduced in the House by one
of its most influential members. The requirement was certainly a most reasonable
one, and, as a matter of fact, of special value to the prospective student of medi-cine
but it was bitterly fought with the usual demagogic arguments of "Medical
Trust," "poor boy," and, after three hot contests, was finally defeated by a
majority of one.
The amendment to the license law, authorizing the Board of Medical Exam-iners,
in its discretion, to modify the requirements of the law and to grant a
limited license, when the conditions in the neighborhood from which the applicant
came demanded it, met with no opposition. Sjjecial acts licensing certain physi-cians
had been introduced and the indications were that they would be passed.
To prevent this kind of legislation, which would mean in the end the practical
destruction of our license law, this amendment was suggested as a compromise
and accepted by the introducers of the bills. This action on the part of those
having the matter in charge has been criticised in some quarters, but it should be
said that a copy of the amendment was sent to every member of the Committee
on Legislation and of the Board of Medical Examiners and was approved or as-sented
to by all, with the exception of a single member of the Board of Medical
Examiners. Those on the ground and familiar with the conditions as they actu-ally
existed in the Legislature felt no doubt whatever as to its wisdom.
Before leaving the subject of legislation, acknowledgment should be made of
the valuable assistance rendered by Dr. Albert Anderson of the committee.
After nearly seventeen years of active and loving service your Secretary lays
down the work with regret, although he realizes that it is best for the work's
sake as well as for his own. He is conscious of many things left undone that
ought to have been done, and perhaps some things have been done that ought
not to have been done, but he has tried to be of some service to the State.
In conclusion, he wishes to express his deep and heartfelt appreciation of the
unfailing and unvarying kindness and courtesy he has received at your hands,
and to most cordially commend to you his successor, Dr. Rankin. Dr. Rankin
he believes to be a man of character, ability, energy, enthusiasm and possessed
of the altruistic spirit so helpful in work of this kind. If the profession in the
28 NORTH CAROLINA BOARD OF HEALTH.
State will hold up his hands and give him their cordial support and co-operation
he will do great things in the coming years for North Carolina.
SMALLPOX REPORT.
Counties.
THIRTEENTH BIENNIAL REPORT. 29
The amount of work accomplished by Dr. Shore, the director, and his two assist-ants,
Miss Allen, Chemist, and Mr. Kellogg, Biologist, when compared with that
of some other laboratories, is, to say the least, unusual. A perusal of the report
of the director, which is appended hereto, will show this. Twenty-three hundred
and ninety-two examinations of specimens of various kinds and the administra-tion
of the Pasteur treatment to eighty-three patients in addition, in one year,
by so small a force, is most gratifying. This could not have been done but for
the kindness of the United States Hygienic Laboratory in furnishing us the virus
free of charge. Not a case has died, and our records, so far, could not be bettered.
In January last the Laboratory was moved to very commodious quarters; it has
been thoroughly furnished with the most approved apparatus and manned by a
force as good as any, and we can confidently expect its increasing usefulness.
The following is the report of examinations made in the State Laboratory of
Hygiene from May 20, 1908, to May 20, 1909:
143 Examinations of feces
—
Positive. Negative.
Hookworm 65 50
Oxyuris vermicularis 1
Ascaris lumbricoides 2
Amoebe coli 2 1
Fly larvae 3
Taenia saginata 1
Tubercle bacilli 2 9
Blood 4 2
Cancer cells • • 1
277 Examinations of sputum for tubercle bacilli 108 169
271 Examinations for diphtheria bacilli 169 102
43 Examinations for malaria 9 34
135 Examinations for Widal reaction 56 79
18 Examinations for gonocoeci 7 11
65 Examinations of brains for rabies 47 18
2 Examinations, bacterial, of pus.
6 Differential leucocyte counts.
122 Specimens of urine, with a variety of bacterial and chemical determinations.
74 Examinations of pathological tissue, as follows:
Carcinoma 15
Chronic inflammation 19
Benign hypertrophies 14
Sarcoma 6
Chondroma 1
Colloid goitre 2
Tuberculosis 10
Pyaemia 2
Verruca 1
Necrosis 1
Doubtful (tissue not well preserved) 1
Placenta 2
2 Examinations of gastric fluid.
1,234 Examinations of water.
2,392 Total.
30 NORTH CAROLINA BOARD OF HEALTH.
Eighty-three patients received Pasteur treatment at this laboratory. Of these,
65 were bitten by dogs in which the disease was demonstrated either by micro-scopic
examination, inoculation experiments in laboratory or by subsequent death
of other animals from a bite; in 17 cases only a clinical history of rabies in the
attacking animal was obtained; in 1 the history was found to be erroneous and
treatment was discontinued; 13 of these cases paid for treatment and the remain-ing
70 were given free treatment. C. A. Shore,
Director.
Dr. Albert Anderson : "As a member of the State Medical Society,
I think some expression of appreciation ought to be made at this time
of Dr. Lewis's work as Secretary of the State Board of Health, and I
am very sorry I am not prepared to speak as the subject demands, for
what I shall say will be from my heart, and what I can remember of his
work, and not extensively said.
"I would be untrue to myself and untrue to the Medical Society not
to say that the North Carolina State Medical Society fully appreciates
and loves Dr. Lewis for the great work he has done as Secretary of the
State Board of Health.
"I am old enough to remember the work of his predecessor, and re-member
when be took charge of this work as Secretary of the Board.
"Dr. Lewis went into it with intelligence, with love and with en-thusiasm.
I have been somewhat in touch with his work from the be-'
ginning. I know how wisely he has planned and how enthusiastically
he has executed his work in every advanced movement. I know, in the
first years of his service, that he planned for large things, and for the
universal good of the people.
"I had the honor to be appointed to take instruction in the Govern-ment
Laboratory, to do some water analyses, many years ago, at his
suggestion, and while my service was small and insignificar* it started
the work that has been more intelligently and wisely done si: je I quit.
"In connection with Dr. Bate, we tried to render the best service that
we could, as beginners, and after we stopped the work was taken up by
the State Laboratory of Hygiene and carried on by better trained men.
Finally the State Board of Health, through Dr. Lewis, secured Dr.
Shore, who stands, I suppose, equal to any man in his work, by long
training and intelligent service that he is now rendering to the State.
"The prospect for State preventive medicine is good, and not only
the Medical Society, but the State of North Carolina, will ever owe Dr.
Lewis a debt of gratitude. He has made history that will never be for-gotten,
and I feel that it would be unjust to ourselves not to say that
we appreciate his services and will always love him for what he has
done in the spread of a better general knowledge of hygiene and pre-ventive
medicine in the State."
Dr. F. R. Harris, Henderson : "I desire to say what I can in refer-ence
to Dr. Lewis. I am not a speaker, but I have a great deal in my
heart to say. I say this because I think preventive medicine in the
State is the most important field, as I see it today, and I want to en-dorse
what Dr. Anderson has said and, furthermore, to endorse Dr.
Shore.
THIRTEENTH BIENNIAL REPORT. 31
"We had an outbreak of diphtheria last season, and I had occasion
to send many specimens to him, and I want to say that the reports that
Dr. Shore made were in accord with the clinical picture, and I believe
they were correct, and he has my confidence, and I desire to commend
him for his work."
Dr. J. T. J. Battle : "I am one of a committee of three appointed to
draft suitable resolutions to express, in some slight degree, the high
esteem in which the Society holds Dr. Lewis, and for the great work
he has done for the Society and for the State."
The Chairman asked all who were in favor of the above to signify
it by rising vote, and the motion was unanimously carried.
Dr. W. S. Rankin : "Mr. President : If I may interrupt for just a
word: I feel that it is a little out of place for me to express myself
here, and I am absolutely unable to express my admiration of Dr.
Lewis's able work in North Carolina. I think that the spirit that has
governed and directed this work is the true altruistic spirit, and I feel
that Dr. Lewis is a greater man than we North Carolinians recognize.
I know that the public health workers of the United States look up to
Dr. Lewis as one of the greatest authorities ; as one of the originators
of public health movements. My slight acquaintance with these men
has convinced me of this fact. I know that Dr. Lewis is a national
figure in hygiene (applause), and has not received the appreciation at
home that he has received abroad.
"In taking up his work the highest ambition that I can cherish is
that I may wear the cloak that he lets fall, half as well as he has worn
it." (Applause.)
Dr. Stiles, being asked by the Chairman for remarks, said
:
"First of all I would like to endorse this resolution offered in regard
to Dr. Le7-is, but I have a delicacy in speaking, as I am an outsider.
"I endo/se, however, the regret the physicians of this State feel in
having Dr. Lewis retire, and this is seconded all over the country. I
have heard many expressions of regret that he was going to give up the
office of Secretary. It is generally recognized, however, that he has se-lected
a good man as his successor.
"To turn to another subject that I was discussing with Dr. Lewis, just
before the meeting came to order ; it was understood that several gentle-men
were going to speak on sanitary matters, and I suggested that when
they spoke we might take up the question of the sanitary privy, so
necessary in this State.
"I think, perhaps, Mr. President, what I have to say on the subject
would come in better after these gentlemen have read their papers, and
I therefore ask that you let me present later what I have to say, after
these papers have been read."
Dr. Lewis : "Mr. President : I would like to announce that there will
be a meeting of the State Board of Health in room 123 at a quarter of
three o'clock, for the purpose of finishing certain work not attended to
on yesterday. There will also be a meeting of the County Superin-tendents
of Health in the tea room at 3 :30, for the purpose of forming a
3
32 NORTH CAROLINA BOARD OF HEALTH.
State organization. I hope these gentlemen will attend, so that we may
have a quorum.
"I desire to say that we have had one hundred and one cases in which
persons have been bitten by rabid dogs since June last, and we have se-cured
from those persons who were able to pay $831.40—the fifty-dollar
fee—for the support of the laboratory."
The Board then adjourned until a quarter to three o'clock.
RESOLUTIONS ADOPTED BY THE STATE MEDICAL SOCIETY ON THE
RETIREMENT OF DR. RICHARD H. LEWIS AS SECRETARY OF THE
BOARD OF HEALTH.
Whereas, Our former and most efficient secretary of the Board of Health, Dr.
R. H. Lewis, has decided it necessary to resign from the position; and whereas,
for the long period of seventeen years of most arduous and difficult labor, he has
accomplished so much, by unfaltering zeal and devotion, for the upbuilding and
the honor of the profession, both of the State of North Carolina and the nation;
and whereas he has so carefully safeguarded the people against the threatened
inroad of disease as to save innumerable lives, the suffering incident thereto, and
great pecuniary loss; and whereas, during these strenuous years, we have seen
and appreciated the results of his great labors: now, wishing to express the
esteem in which he is held, not alone by the profession, but the laity, be it
hereby
Resolved, first, That this Society express its conviction that he has done more,
both in his official and individual capacity, than would have been possible for
any other one to have done.
Resolved, second, That we with reluctance accept his resignation, realizing that
we lose in some measure his great capabilities and far-reaching influence.
Resolved, third, That he, having been such a potent factor with the Legislature,
has saved us from impending adverse legislation and secured such salutary meas-ures
as are responsible for our present advanced position in sanitary work.
Resolved, fourth, That we earnestly implore him to give us yet his wise counsel
and help in time of difficulty and threatened legislation.
Resolved, fifth, That it is our sincere wish and prayer that he, having done
so much for sanitation and the health of others, may himself be blessed with
many future years of vigorous health and abundant enjoyment of the blessings
and happiness of life.
AN APPRECIATION.
In the retirement of Dr. Richard H. Lewis as their secretary, the State Board
of Health has lost a most efficient officer and the public a most devoted servant.
Dr. Lewis's tenure of office has bridged an important stage in the development
of public health work. Our understanding of the true nature of communicable
disease had its beginning in the discovery of Van Loewenhoek, a lens polisher,
of Delf, Holland, in 1G83. From its beginning, in that year, to 1850, the idea
that minute germs caused disease was but a theory, and but little more than
theory, supported by only circumstantial evidence, till 1880, when Robert Koch
transformed the theory into a scientific fact, and in so doing laid the sure foun-dation
for preventive medicine and public health. For the next ten years these
new facts filtered slowly through the medical profession, reaching the general
public about 1890, when the public began to grasp the true meaning of preventive
medicine.
THIRTEENTH BIENNIAL REPORT. 33
As Dr. Lewis was elected secretary of the Board of Health in 1892, the begin-ning
of his official life was coincident with the real beginning of preventive medi-cine.
It therefore became his task to nurse this great movement in its early and
tender years, in the years so important to future development, when the founda-tion
so essential to what is to follow is being laid. How well he has performed
this task is not for the writer to say, for on this question the present status
of public health in North Carolina and the best public health authorities in
America have handed down an opinion.
As the present condition of public health in North Carolina is largely the
result of Dr. Lewis's labors, in conjunction with the Board of Health, it may be
taken as the best evidence of his ability as a sanitarian. His best work is prob-ably
recorded in the statute books of the State. With the exception of the act
establishing the State Sanatorium for Tuberculosis and an act separating the
tuberculous prisoners from the well, he either drew up entirely or materially
modified before introduction all the laws bearing on public health, and was
active in securing their passage by the various Legislatures. In this connection
credit is due Col. J. L. Ludlow, the able sanitary engineer of the Board, for
preparing the sections in the amendment to The Revisal of 1905 adopted by the
last Legislature, giving the Board more power in controlling public water sup-plies
and in suggesting the advisability of analyzing the waters of springs at
resorts while open for the entertainment of the public. As long ago as 1902
North Carolina was recognized by the American Public Health Association as
one of four of the foremost States in water legislation. Dr. Lewis, with the con-currence
of the Board of Health, developed the Laboratory of Hygiene upon the
original plan of taxing all corporations or individuals selling water to the public
for its support, supplemented by an annual appropriation of $2,000 which he
secured from the Legislature of 1907. Another law very much to his credit is
our new vital statistics law. Dr. Creesy L. Wilbur, Chief Statistician of the
United States Bureau of the Census, has said of this law that it was "the first
practical vital statistics law enacted in any of the Southern States." As correct
vital statistics form the very basis of intelligent public health work, the value
of this law is at once evident. As law is the result of public sentiment, and
public sentiment the result of education, these laws are the result of an effectual
educational campaign for the improvement of public health. To this Dr. Lewis
has contributed through his editorial work in the Bulletin of the State Board
of Health and through many noteworthy publications and addresses. Among
these may be mentioned his "Drinking Water in Relation to Malarial Diseases,"
which started the change in Eastern Carolina in the domestic water supply from
open wells to driven pumps; his "Instructions for Quarantine and Disinfection";
his leaflets on typhoid and malaria ; his pamphlet on the prevention of tuber-culosis,
pronounced by good judges to be the best of its kind. A leading health
officer of the State of New York has said that 90 per cent of the anti-tuberculosis
work in that State was based upon Dr. Lewis's presidential address before the
National Conference of State and Provincial Boards of Health of North America.
The opinion of the great health officials of America of Dr. Lewis is shown by
the recognition they have accorded him in having made him president of both
the great national public health associations. In 1905 he was president of the
National Conference of State and Provincial Boards of Health of North America,
and in 1907 he was president of the American Public Health Association. It
is therefore \ery evident that the retiring secretary is a national figure in public
health work.
34 NORTH CAROLINA BOARD OF HEALTH.
When it is remembered that the small amount of $2,000, out of which clerk's
hire, etc., was to be taken, was all appropriated by our State, it can readily be
seen that the secretary's service was largely a labor of love. Forced on account
of this small appropriation to practice his profession, as an oculist, to earn a
living, he has given his resting hours to the service of his country, thereby show-ing
a self-sacrifice for public weal which should always be an inspiration to those
who follow him.
The writer fully realizes the embarrassment he takes upon himself in calling
attention to the high standard set by his predecessor, but a sense of gratitude
and duty, both as an individual and as a public official, will be satisfied with
nothing less. In assuming his official cloak I shall always be mindful of him
who wore it so worthily.
Meetings of Executive Committee
Office of the Secretary,
Raleigh, K 0., August 10, 1909.
At the request of the President, the Executive Committee was called
to meet at the office of the Secretary in Raleigh on August 10th, 1909
;
the object of the meeting being to consider the sanitary condition of the
State Sanatorium for the Treatment of Tuberculosis, the purification of
sewage at Rocky Mount and Tarboro, the purity of the Reidsville water
supply and to confer regarding Public Water Supplies, Circular B.
Dr. Thomas, President, called the meeting to order at twelve o'clock,
Dr. Lewis and Col. Ludlow being present.
Dr. Gordon, President of the Board of Directors of the State Sana-torium
for the Treatment of Tuberculosis, and Dr. Julian, Assistant
Secretary for Tuberculosis of the State Board of Health, appeared be-fore
the Board. Dr. Julian's report* of the sanitary condition of the
State Sanatorium was read, to which Dr. Gordon replied:
DR. GORDON'S STATEMENT.
"1. In regard to there being 'no matron or nurse in the institution,' the ex-planation
is: One reason that there is no matron and no nurse is that we have
no place for white help, no means for providing such a place and that it is abso-lutely
impossible to get a nurse or matron there and expect them to live with
the inmates of the institution.
"2. That the 'windows and doors are not provided with screens; the kitchen
and dining room swarm with flies' : Now, if you remember, the appropriation
made for this institution was one of the last bills passed by the last Legislature
and, if I remember correctly, I called a meeting of the directors perhaps early
in April. I was not at that meeting, being unable to attend. Since then we
have let a contract to Mr. Dew to screen the windows and doors and also
to provide screens to keep out rain, for every apartment in the institution. For
some cause he was very slow about it. He got part of the material there and
failed to get the remainder. The result was that the doors and windows were
never screened, that is, not until now. He is doing this work, now.
•See page 88 for Dr. Julian's report.
THIRTEENTH BIENNIAL REPORT. 35
'"I stayed at Montrose a few days, in order to ascertain the true conditions. I
ate in the dining room every meal, save one, while I was there, and there were
some flies, but I do not think there was the number of flies indicated by the
report here. I have certainly seen a great many more flies than I ever saw in
that dining room, and I did not note that there was an unusual number of flies
in the kitchen, although I had my own table and there may have been more flies
at the other table.
"The food was fairly well prepared, and while I was there the quality and
quantity was fairly good.
"3. 'Xo protection from rain,' etc.: I replied to that a while ago. Last year,
when the institution was opened, we curtained the building with heavy ducking
strung on wire so that during rains the curtains might be used to protect; but
the wind is so strong there that this arrangement was found to be a failure;
the ducking was blown off and it was finally taken down.
"4. I do not know when the floors had been cleaned. When I went down there"
I went to look after the installation of an electric plant. Dr. Brooks informed
me that he wanted to go away for a little rest, and asked me if I would look
after the patients. I told him that I would do the best I could. He met me at
Aberdeen. He did not go out to the institution with me, and told me nothing,
leaving me thus uninformed. I introduced myself to the patients, examined them
and saw them every morning and afternoon while I was there, in the meantime
looking after the building and installation of the plant. My observation is that
the cracks in the floors were unusually small, but it is possible that there was
some dust and dirt in them. The floors had not been swept the morning Dr.
Julian a.nd Dr. Stanton were there, and the beds, I suppose, had not been made
up that day.
"I think it but due to Dr. Brooks that I make this statement. The doctor has
found it impossible to get efficient help. One of the reasons is the reason already
stated, that he has no place to keep efficient help. No one would stay there
except inefficient help. He was exacting and insistent on their doing what he
said. The only way he kept his cook was by not paying him, so he could not go
away. He was dreadfully handicapped. His laundryman would not work for
him. When I got there I found the laundry had not been done for some time,
and Miss Lock told me she could not get it done. Miss Lock was a patient there
who had improved and was acting as matron. She told me that laundry work
was needed to be done badly. I asked whom she could get. She said it had been
done by a woman, but she had quit and could not be induced to return. I asked
regarding the cook, and she said she was a good washerwoman. Miss Lock said if
Charlotte, the cook, would do the laundry, she, with the help of William, would
do the rest, and so I made arrangements to have her wash the bed linen. I kept
Charlotte at that for a number of days. She laundered all the bed linen, except
what was then in use. I found the blankets had all been used and needed to be
laundered, so I sent for the party that had done laundry work for them since
the institution opened there, and she agreed to launder the blankets and the bed
linen, as well as to do the laundry work for the patients. I got her to do this
work until I left there. All the blankets had been used, but had not been used
an unreasonable length of time.
"5. 'Ventilation of the rooms bad' : We have a number of windows in the
assembly hall, and my observation was that the windows were nearly always
36 NORTH CAROLINA BOARD OF HEALTH.
open. At any rate this hall was used very little except for lavatory purposes
and writing. The patients sleep out of doors and live out of doors.
"The slops while I was there were kept thoroughly disinfected with bichloride
of mercury, and Dr. Brooks claims he has also used a large amount of bichloride
of mercury. While they did not look sanitary, they were all right.
"6. 'No bath tubs': Well, there are no bath tubs. We intend to put in shower
baths, instead, but have no money with which to put in any.
"7. 'There are two privies. There was no evidence that they have been cleaned.
No disinfectants have been found, no covers to stools, and odor offensive.' You
can not get any negro in that country to clean out one of these privies for the
institution, and the only means was to take a hand from the farm to do it. I
asked this man about the privies—he cleans them out—and he said he had been
intending to do it for several days. I asked him how long it had been since they
were cleaned out, and he said two weeks. I told him to clean them out, and Dr.
Brooks has since burned them down.
"8. There is nothing in this to reply to. He states it is crude and also thinks
it might have been more sanitary. We admit that : it could have been and should
have been. I think Dr. Brooks should have due credit. He had no efficient help
and no matron capable of filling the position, because no one would stay there.
No trained nurse would stay there. There was no place for colored help, the
only place being a pallet in the kitchen and one in the entry or butler's pantry.
I think Dr. Brooks should be credited with the fact that no provision had been
made by which he could keep efficient help, and he is certainly due the credit of
having appeared before the Executive Committee and insisted that the institu-tion
be closed during the hot weather and pending the improvements that were
contemplated. He insisted on it and one member of the Executive Board was
very much opposed to closing the institution, and I think the Executive Board
is solely to blame for its not being closed at the proper time.
"The whole thing in a nutshell is this: The Board of Directors, in their zeal
to demonstrate to the Legislature the good that could be derived from the in-stitution,
permitted the institution to be opened before it was properly equipped
—that is, before we had an institution. That was the mistake made, and we
feel that the members of the Board realize that now. At the same time we
thought it would help us in getting additional appropriation, without which we
could not have continued the work. (Dr. Lewis: "It did help.")
"If you will permit me, I should like to express my views in regard to this
report. It is no reflection on Dr. Julian. Dr. Julian did his duty as he saw it,
and I do not mean to reflect on anybody. At the same time it seems to me
that, as officials of the State and in the interest of the entire people of the State,
it would be unwise to make a public document of this report, believing, as I do,
that it will raise up and interfere, very materially, with any additional appro-priation
that may be asked for at the hands of the Legislature."
DR. JULIAN'S STATEMENT.
"In the first place, I desire to say that the condition shown us by Dr. Gordon
was just as good as it possibly can be and just as nice as his defense today.
When I was down there he gave me every opportunity to examine the institution.
He very kindly took us over the grounds; and I wish to say that the grounds,
elevation and soil are ideal, and that I know of no place in North Carolina that
would equal it for this work. These conditions are the best I have ever seen
THIRTEENTH BIENNIAL REPORT. 37
and the elevation I am sure is sufficient for the treatment of tubercular affections,
and in fact I think the possiiblities are really greater than in any other place in
North Carolina.
"I also wish to say, that there may be no prejudice to my report, that I have
had no communications from any one in North Carolina, layman or doctor, in
regard to this institution, except from Dr. Eankin, by letter, that I am not in
sympathy with any man or men that are trying to get the superintendency of
the institution, and that I really had expected to visit Montrose in the capacity
of the Assistant Secretary for Tuberculosis, and was glad to make this visit
officially, at the request of Dr. Rankin, our Secretary.
'•When I arrived at Aberdeen I found the little Rockfish and Aberdeen was in
such perfect condition sanitarily; the coaches were so clean, that I made the
remark to one of my friends that if we found the institution as well cared for,
I would be well pleased. I desire to say this, so that it will be understood that
I am not prejudiced.
"I also wish to say that I took the names of every person in the institution
before I told them my mission; inquiring into their habits and treatment, and
that except for Dr. Gordon, who was held in very high esteem, the treatment
was a joke among the patients. They spoke very highly of Dr. Gordon, but the
treatment was a joke.
"I looked around for appliances for examination. They had no microscope or
stethoscope. (Dr. Gordon: "I had that in my pocket." ) One patient complained
that he had been in bed two weeks with a temperature of 105 and that he had
only had his temperature taken by himself. That the doctor had not taken his
temperature all the while. Now, I have in my grip the names of every one who
gave me this information. I was told by one patient that from the time he
had entered until that day he had never had an examination, percussion, or aus-cultation,
or anything.
"Miss Lock was the only one that did anything at all in -he way of a matron.
She informed me that she was a patient, without salary, and was left to do as
best she could, without directions or orders, except what she received from Dr.
Gordon. It seems that they had no cows, and the first churning was done the
day I arrived at the institution. The butter and eggs were ordered from Aber-deen
and were usually stale. The other food was good. It appears that the
visits from the doctor in charge were only from Aberdeen and that he did not
remain at the institution. It is also claimed that the beds were changed from
one part of the porch to another by a negro man when it rained at night. One
patient informed me he had been there thirty-four days and, to his knowledge,
there had been no change of linen in that time. Others claimed that the linen
had not been changed for about two weeks. The beds on the porches were in dis-order.
They were turned helter-skelter, the sheets were dirty, and, as Dr. Gordon
remarked, after the sheets were used they were thrown up in a heap on an old
bed in one part of the porch in an unsanitary condition. It had rained the night
before and that part of the porch was wet and in an unsightly condition. A
patient informed me that he had accidentally turned his spit cup over on his
linen and that the only way he could get rid of it was to wash it out himself.
I observed the patients sitting around with rolls of toilet paper near by. They
would cough and expectorate into this toilet paper and then slip it into a bag,
and after that was filled it was disposed of in the fire. That I saw.
"A patient informed us that the porch had not been swept for a month and
38 NORTH CAROLINA BOARD OF HEALTH.
that the rooms had been swept once in two weeks, and that with a dry broom.
There was no cloth to moisten the floor. The sweeping was done by dry cleaning.
These were patients in advanced stages of tuberculosis, others without tempera-ture
and others with temperature and were then huddled in, and of course rein-fection
could occur with the sweeping, everywhere there was a dry sweeping.
"In answer to Dr. Gordon I should say the talk I had with him was satisfactory
and that I have the highest regard for him. He said Dr. Brooks had given him
no information in regard to the institution and he was obliged to go to work for
himself. He went out there handicapped. They were living there with no method
of ordering, except for this woman (Miss Lock), who was a self-appointed
matron.
"In regard to the cracks: They were no larger than ordinary cracks. They
were not filled like this floor, and all the dirt that could, accumulated in the
cracks. The floors should be waxed, and there is no excuse for neglecting this
matter, as turpentine and beeswax could easily be mixed together and the floors
waxed therewith.
"In answer to that part of Dr. Gordon's defense of Dr. Brooks, wherein he
states that he could not get a trained nurse, all that is Dr. Brooks's fault. The
report from Whitehaven and like institutions show that the danger of infection
of nurses and help is less in sanatoriums than in private houses.
"There is no reason why any physician should fear to sleep in any part of such
an institution, and there is no reason why any woman who has been trained as a
nurse should object to going to any kind of an institution if she is capable of
taking care of it.
"In regard to the kitchen and dining room, the use of the word 'swarm' does
look a little harsh, but they were preparing vegetables and the negro cook was
spreading them all over the table, and, in the absence of screens, there was no
reason why the flies should not be on the food; of course, on the cooked food as
well as on the raw. One patient told me that while one of them ate at the
table another would keep the flies off with a flybrush.
"I did observe a bed in the dining room, one in the pantry, and one in the
kitchen. These were without bedsteads; just piled down on the floor. A negro
man slept in the kitchen and a negro woman in the dining room.
"The privies are near the institution. The seat was some distance from the
ground and the accumulation of fecal matter extended from the ground to within
a few inches of the seat. The seat was without a cover, and no lime or other
disinfectant was seen around the privies.
"Besides the sanitary condition, the possibilities are so great that the insti-tution
must, in somebody's hands, or by your wise directions, be made an honor
to the State of North Carolina. The sanitary conditions of the institution are
inexcusable, It is inexcusable to have beds in the condition I found them in,
there. It is inexcusable to leave stools from early in the evening until the next
day at 12 o'clock, and this I saw.
"Suppose a patient comes there in the more advanced stage of tuberculosis
—
suppose he should have a hemorrhage at night. Who is to take care of patients
at night?"
Resolution : Introduced by Col. Ludlow.
"1st. That the Executive Committee endorse the activity and zeal on the part
of the Secretary and Assistant Secretary for Tuberculosis in their investigation
and complaint they have lodged against the State Sanatorium for Tuberculosis.
THIRTEENTH BIENNIAL REPORT. 39
That the Committee, after hearing this report and the discussions, does refer
the entire matter to the board of directors of the institution for their further
consideration and action. Further, that the Executive Committee, acting in its
official capacity as custodian of the public health of the State, the matter having
been referred to them officially, recommend to the board of directors of the in-stitution
that it shall not be opened for the treatment of patients until the con-templated
improvements have reached such a stage that the patients entering can
be properly cared for.
''Further: In reference to the complaint lodged by Dr. J. R. Williams, it is
likewise referred to the board of directors for their consideration and action."
The question of sewage disposal at Rocky Mount and Tarboro being
brought up, Mr. Battle said
:
"It is useless for us to discuss the matter with you on a scientific
basis.
"We insist that we are situated 68 miles above the only intake of a
public water supply. In view of that distance, the slow flow of the
stream, the size of the river at Rocky Mount and Greenville, and the
amount of sewage produced by Rocky Mount, your order was entirely
unnecessary and we insist that it be revoked. At the same time we know
the law,—no sewage shall be turned into a stream from which water is
taken below.
"The town of Rockv Mount, without any fault of its own, is entirelv
out of money with a floating debt of $20,000. It is absolutely impossible
for us to raise that amount of money, in any way. Our only recourse
would be to break the sewer entirely and keep sewage from running
into the river. This would cause a pestilence in the town, besides ruin-ing
our new $20,000 hotel. We can not consider giving up the sewerage
system. The whole matter of sewage purification is in an exceedingly
incoherent (?) state; as just shown by the Westinghouse agent. To put
our town to an expense that in a year or two would prove to be unwise
and inexpedient is unjust and oppressive.
"I would like to file with you the annual financial report of the city
of Rocky Mount (gives the Secretary a paper).
"What we wish to do, when our funds permit, is to install a septic
tank."
Mr. Bassett, for Rocky Mount, states financial condition of Rocky
Mount
:
"Our town has an increased demand of $8,000, and a decreased rev-enue
of $12,000, by reason of the prohibition law. The estimated flow
of sewage is 150 gallons per minute. The estimated flow of the river
is 1,275 gallons per minute. (Reads Section 3058 of Revisal of 1905.)
Greenville has filed no complaint. It is absolutely beyond the means of
Rocky Mount to install the system required by Colonel Ludlow. (Reads
a letter describing the system suggested by Colonel Ludlow.) Xo en-gineer
would require more of the country of England than Colonel
Ludlow requires of Rocky Mount. We will leave this matter in your
hands, absolutely assured that we will be dealt with justly and fairly."
40 NORTH CAROLINA BOARD OF HEALTH.
Mr. W. O. Howard, for Tarboro
:
"We feel that we are almost unable, in fact, that it would be almost
impossible for us to comply with your order. We are poorer than any
Eastern town. Tarboro has the highest tax of any Eastern North Car-olina
town, being $2.58 per hundred, for the town, county and State.
I am here to ask you to revoke your order for the present. With the
next meeting of the Legislature we may be able to comply. The system
demanded by Colonel Ludlow would require the expenditure of $68,000
and the annual running expenses would probably be $1,000. If you
can not revoke the order, do not require us to put in such an expensive
system. Greensboro has a septic tank which cost only $2,000. We cer-tainly
can not comply within six months. In order to do this, we shall
have to make some provision for levying more tax."
Colonel Ludlow : If Greenville's filter should fail to work one day,
the health of the town would be endangered. I can not possibly weigh
the danger to Greenville against the financial condition of Rocky Mount.
On motion of the Chairman, it was resolved that the time for the
installation of hygienic purification plants by the towns of Rocky Mount
and Tarboro be extended to July 1st, 1910.
REIDSVILLE.
Colonel Ludlow showed chlorin in this supply to be too high at all
times.
It was decided that the Secretary should visit Reidsville and look into
the matter of their water supply.
On motion the Engineer and the Secretary of the Board and the
Directors of the Laboratory of Hygiene were directed to make an in-spection
of the electrical purification of water and its practical appli-cation.
Raleigh, K C, February 9, 1911.
Dr. Jno. A. Ferrell, having been recommended to the Rockefeller
Sanitary Commission by Dr. Richard H. Lewis and Hon. J. Y. Joyner,
was requested by Dr. Lewis to meet Dr. Wyckliffe Rose, Administrative
Secretary of the Rockefeller Sanitary Commission in Raleigh, Feb-ruary
8th, 1910.
At this meeting Dr. Rose decided to recommend Dr. Ferrell's ap-pointment,
provided the State Board of Health, through its Executive
Committee, would approve the appointment.
The following day, Colonel J. L. Ludlow was called up by long dis-tance
telephone by Dr. W. S. Rankin, Secretary to the Board, and put
into possession of all the facts relating to Dr. Ferrell's appointment.
Thereupon he approved the appointment. Dr. Thomas later approved
the appointment by letter.
Dr. Ferrell was then appointed by the Rockefeller Sanitary Com-mission
as Assistant Secretary for the Eradication of Hookworm of
the State Board of Health. After arranging his local business he came
to Raleigh, taking charge of his official duties March 12, 1910.
THIRTEENTH BIENNIAL REPORT. 41
Annual Sessipn of the Board of Health
Wrightsville, N. C, June 21, 1910.
The annual session of the Xorth Carolina State Board of Health was
called to order by President Thomas.
Members present : Doctors Lewis, Anderson, Tayloe, Register, Way,
Spencer, and Colonel J. L. Ludlow.
Minutes of Asheville meeting June 15-16, 1909, were read. Colonel
Ludlow corrected the minutes by requesting that he be not referred to
as "Sanitary Engineer of the Board," but as a member of the Board.
The minutes were then approved.
The minutes of the meeting of the Executive Committee on August
10th, 1909, were then read and approved.
Letters, under dates of June 2 and June 4, 1910, from Jno. A. Wed-dell,
Clerk of Tarboro, and Hon. T. T. Thorne, Mayor of Rocky Mount,
were read. Both of these letters requested an extension of the time pre-viously
allowed the towns of Tarboro and Rocky Mount from July 1,
1910, to November 1, 1909. The Board, appreciating the cordial spirit
of co-operation expressed in these letters, and accepting in good faith
their statement to the effect that it was impossible for them to comply,
through no fault of their own, with the requirement for installing sew-age
purification plants by July 1st, passed the following motion intro-duced
by Dr. Lewis
:
"Moved that the towns of Tarboro and Rocky Mount be granted an extension
of time to January 1, 1911, for installing sewage purification plants."
As above stated this motion was carried. Dr. Lewis suggested that
the Secretary remind the above towns to submit to the Board plans of
the proposed purification plants according to Section 3058, Subsection
(b), before proceeding with their installation.
The minutes of the approval by the Executive Committee of Dr. Jno.
A. Ferrell's appointment as Assistant Secretary for the Eradication of
Hookworm were read and approved by the Board.
Dr. "Way officially notified the Board of the death of one of its mem-bers,
Dr. James A. Burroughs, and moved that a committee be appointed
to draft suitable resolutions regarding his death. Dr. Way was then
appointed by President Thomas a committee of one to prepare such
resolutions.
Dr. Anderson moved that Mr. H. W. Simpson be re-elected a mem-ber
of the Board of Embalmers. This motion was unanimously carried.
Dr. Lewis moved that the Board go into the election of a new member
to fill the vacancy made by the death of Dr. Burroughs.
Dr. Way nominated Dr. J. E. Ashcraft, of Monroe, for this position.
Dr. Ashcraft's nomination was seconded by Dr. Spencer and Colonel
J. L. Ludlow. Dr. Register made a number of commendatory remarks
concerning Dr. Ashcraft. Dr. Ashcraft Avas then unanimously elected.
President Thomas then appointed Colonel Ludlow and Dr. Spencer
an auditing committee to audit the accounts of the Treasurer of the
42 NORTH CAROLINA BOARD OF HEALTH.
State Board of Health and the State Laboratory of Hygiene. The ac-counts,
statements, checks, and receipted bilts were then turned over by
the Treasurer to Dr. Spencer.
Dr. Spencer moved that the meeting be adjourned. The motion
was carried.
W. S. Rankin, Secretary.
Conjoint Session of the North Carolina Board of Health
with the Medical Society of the State of North Caro-lina,
at Wrightsville, June 22, 1910.
President G. G. THOMAS, Chairman.
REPORT OF SECRETARY STATE BOARD OF HEALTH.
Mr. President, Members of the North Carolina State Board of Health, and Mem-bers
of the Medical Society of the State of North Carolina.
I have the honor to submit herewith my annual report as Secretary of the
North Carolina State Board of Health as authorized by Section 4442 of The Re-visal
as amended by the Legislature of 1909.
My first record is a sad one, namely, to note the death of the lamented Dr.
James A. Burroughs, a member of this Board and late President of this Society.
Dr. Burroughs heard the summons of our common adversary, and on December
28, 1910, fell in the front line of the battle of science against death. His death
leaves a vacancy on the Board of Health which should be filled at this meeting.
The most important, as well as the most encouraging, change that has taken
place since our last meeting is the continued and vigorous growth of the public
interest in the question of health. This growing interest finds expression through
several sources.
Medical inspection of schools, carried on during the last three years and in-cluding
schools in England and in various parts of the United States with an
aggregate of about one million pupils, has shown that 20 per cent of the children
have defective eyes, 5 per cent of them have defective ears, and about 10 per cent
defective throats. The large number of children examined and the extensive
geographical distribution of these statistics establish a condition that is general.
So large a number of physical defectives in the schools means the retardation of
the entire school; means a tremendous loss through the retardation of all the
children, and the inability of a large number of children to use what is taught
them ; means that many physical defectives are unjustly punished, whereby many
sweet dispositions are soured and many characters are twisted. These facts, to-gether
with the general growth of public health interest, have gone a long way in
causing the school people to recognize the fundamental value of health and in
making of them one of the strongest forces in the public health movement.
Through the deep interest of State Superintendent of Public Instruction
Joyner, your Secretary has addressed both the Association of County Superin-
THIRTEENTH BIENNIAL REPORT. 43
tendents of Public Instruction and the North Carolina Teachers' Assembly, in
addition to several teachers' institutes, on the question of public health. The
November issue of the Bulletin was a teachers' edition and dealt with the re-lation
of the public school to health. Four thousand North Carolina teachers
are on the mailing list of the Bulletin. In December your Secretary prepared
a pamphlet dealing with the construction and care of sanitary schoolrooms and
the examination of children by teachers for defective eyes and ears. The major
part of this pamphlet was taken from a silimar publication prepared several years
ago by former Secretary Lewis. This pamphlet was issued and distributed by
the State Department of Public Instruction. In February of this year another
pamphlet on the subject of tuberculosis was prepared by Assistant Secretary
C. A. Julian. This was published by the State Department of Public Instruction,
but, on account of some delay, it was thought best to wait until the next public
school year to distribute it.
While, at present, the study of sanitation and preventive medicine is not pre-scribed
in the public school course, many influences are at work toward this end.
The teachers are feeling the effect of the popular demand for health study, and
in many schools health is receiving attention in one way or another. I am led
to believe, from a recent conversation with State Superintendent Joyner, that
at the next meeting of the Board for the Selection of Text-books, some time dur-ing
the year 1911, the subject of sanitation and preventive medicine will be pre-scribed
for the public school system.
At the request of Superintendent Joyner, a series of sixty health talks, cover-ing
the subject of public health, will be prepared during the summer for the
public school teachers. The talks will be published in convenient form for the
use of the teachers, and distributed. The teachers will use them as the basis for
three ten-minute talks to the school each week on the subject of health.
In this connection I wish to call your attention to and ask your support for
the School Betterment Associations. These associations, now established and
active in many counties, are doing much for public health by insisting on better
sanitary conditions in and around schoolhouses.
Many physicians have made health addresses before schools and teachers' in-stitutes
during the last year, and, in this way, have contributed much to the
public welfare. Permit me to commend this practice to all those physicians
whose public interest is seeking a wider sphere of usefulness.
The churches, along with all other organized influences, have deepened their in-terest
in the question of health, and many pulpits have contributed largely to the
cause of more efficient and cleaner living as a means of better preparation for
the other life. In March of this year a special Preachers' Bulletin was issued
for Sanitary Sunday, April 24th. This Bulletin contained the endorsement, for
its use by the preachers of various denominations, of many of the leading clergy-men
in the State. I am sure this Bulletin was used by many of the pulpits, and
I desire here and now to make grateful acknowledgment of this fact.
The press of the State is showing its awakening sense of responsibility for
public health by more frequent expressions on this subject. Your Secretary had
the pleasure of addressing the Press Association on their relation to the public
health, at their recent meeting in this place. They seemed to be deeply interested
and promised their cordial cooperation with the State Board of Health for health
improvement. I am quite sure that the press is becoming seriously interested in
this problem, and their interest will go a long way toward creating a demand
for a better health administration, local and State.
44 NORTH CAROLINA BOARD OF HEALTH.
The American Tuberculosis Exhibit, under the direction of Mr. E. G. Routzahn,
has been at work in our State since March 15th. It has already given three ex-hibitions
of three weeks each, in the cities of Greensboro, Raleigh, and Winston-
Salem. It will go to Durham later this summer, and it is hoped that Charlotte
will secure the exhibit for the fall. The effect of this exhibit is to tremendously
augment the local health interest wherever it is given, and to create a general
interest in health in the surrounding country.
Last, but by no means least, of the organized influences that have seriously
interested themselves in better health is the State Federation of Women's Clubs.
At their recent annual meeting in Henderson your Secretary addressed them on
the subject of public health, and they expressed their deep concern in the cause
by passing resolutions emphasizing its importance and organized a Health De-partment
of the Federation. Mrs. W. N. Hutt, of Raleigh, was made chairman
of this department.
The Monthly Bulletin of the Board of Health has been increased in its
circulation from 3,500 to 11,500, and its mailing list includes all the doctors,
preachers, lawyers, and 4,000 of the 10,000 school teachers in the State. There
are, in addition, a number of other names on the mailing list. The Bulletin
also reaches most of the newspapers of the State.
The Legislature of 1909 passed three important public health measures: A
law relating to the control and care of public water supplies, a law requiring
the registration of all deaths occuring in towns or cities having a population of
a thousand or more at the last decennial census, and a law providing for the
distribution of diphtheria antitoxin to the indigent. Former Secretary Dr. Lewis
has already called attention, in the March (1909) Bulletin, to the nature of
these laws. All of them have been put in operation during the last year.
The law relating to water supplies requires the authorities of every public
water supply to file certified duplicate plans and surveys prepared according to
rules and regulations furnished them by the Secretary of the State Board of
Health. Of the 63 public water supplies of the State, 45 have complied with this
requirement. Eighteen have not complied, and the attention of the solicitor has
been called to the infringement of this law in the case of one company, the other
fourteen having rendered acceptable excuses for their delay. This law further
requires the authorities in charge of all public water supplies to make quarterly
ins

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THIRTEENTH BIENNIAL REPORT
OF THE
NORTH CAROLINA STATE BOARD OF HEALTH
1909-1910
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1909-10
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DANiEL & WARREN
THIRTEENTH BIENNIAL REPORT
OF THE
NORTH CAROLINA
STATE BOARD OF HEALTH
1909-MO
RALEIGH
Edwards & Broughton Printing Co., State Printers
1911
Members
G. G. Thomas, M.D., Pies., Wilmington.
Thomas E. Axdersox, M.D., Statesville.
J. Howell Way, M.D., Waynesville.
W. 0. Spexcer, M.D., Winston-Salem.
Edw. C. Register, M.D., Charlotte.
David T. Tayloe, M.D., Washington.
*J. A. Burroughs, M.D., Asheville.
J. L. Ludlow, C.E., Winston-Salem.
Richard H. Lewis, M.D., Raleigh.
•Deceased. Succeeded by J. E. Asheraft M.D.. Monroe.
County Superintendents of Health
Alamance Dr. G.
Alexander Dr. 0.
Alleghany Dr. B.
Anson Dr. J.
Ashe Dr. J.
Beaufort Dr. P.
Bertie Dr. J.
Bladen Dr. L.
Brunswick Dr. J.
Buncombe Dr. D.
Burke Dr. I.
Cabarrus Dr. J.
Caldwell Dr. C.
Camden Dr. C.
Carteret Dr. W
Caswell Dr. S.
Catawba Dr. H.
Chatham Dr. L.
Cherokee Dr. J.
( lmwan Dr. H.
Clay Dr. J.
Cleveland Dr. T.
Columbus Dr. H.
Craven Dr. J.
Cuml>erland Dr. W,
Currituck Dr. H.
Dare Dr. . .
Davidson Dr. E.
Davie Dr. M
Duplin Dr. T.
Durham Dr. X.
Edgecombe Dr. S.
Forsyth Dr. J.
Franklin Dr. J.
Gaston Dr. X.
Gates Dr. G.
Graham Dr. M.
Granville Dr. S.
Greene Dr. W
Guilford Dr. A.
Halifax Dr. I.
Harnett Dr. L.
Haywood Dr. J.
Henderson Dr. J.
Hertford Dr. J.
Hyde Dr. K
W. Long Graham.
L. Hollar Taylorsville.
0. Choat Sparta.
M. Covington Wadesboro.
C. Testerman Jefferson.
A. Nicholson Washington.
L. Pritchard Windsor.
B. Evans Clarkton.
A. Dosher Southport.
E. Sevier Asheville.
W. Phifer Morganton.
W. Wallace Concord.
L. Wilson Lenoir.
G. Ferebee Gregory.
E. Headen Morehead City.
A. Malloy Yanceyville.
E. Rowe Newton.
E. Farthing Pittsboro.
F. Abernethy Murphy.
M. S. Cason Edenton.
M. Sullivan Hayesville.
E. McBrayer Shelby.
B. Maxwell Whiteville.
F. Rhem Xew Bern.
S. Jordan Fayetteville.
M. Shaw Shawboro.
J. Buchanan Lexington.
. D. Kimbrough Moeksville.
O. Coppedge Kenansville.
M. Johnson Durham.
P. Bass Tarboro.
K. Pepper Winston.
E. Malone Louisburg.
L. Glenn Gastonia.
D. Williams Gatesville.
T. Maxwell Robbinsville.
D. Booth Oxford.
. B. Murphy Snow Hill.
T. Fortune Greensboro.
E. Green Weldon.
F. Arnold Lillington.
R. McCracken Waynesville.
G. Waldrop Hendersonville.
H. Mitchell Ahoskie.
E. Windlev Lake Landing.
Iredell Dr. M. E. Adams Statesville.
Jackson Dr. A. S. Nichols Sylva.
Johnston Dr. A. H. Rose Smithfield.
Jones Dr. A. F. Hammond Pollocksville.
Lee Dr. J. P. Monroe Sanford.
Lenoir Dr. N. A. Whitaker Kinston.
Lincoln Dr. J. W. Saine Lincolnton.
McDowell Dr. Guy S. Kirby Marion.
Macon Dr. S. H. Lyle Franklin.
Madison Dr. W. J. Weaver Marshall.
Martin Dr. W. E. Warren Williamston.
Mecklenburg Dr. C. S. McLaughlin Charlotte.
Mitchell Dr. V. E. Butt Bakersville.
Montgomery Dr. C. Daligny Troy.
Moore Dr. Gilbert McLeod Carthage.
Nash Dr. J. P. Battle Nashville.
New Hanover Dr. W. D. McMillan Wilmington.
Northampton Dr. H. W. Lewis Jackson.
Onslow Dr. Cyrus Thompson Jacksonville.
Orange Dr. C. 0. Jones Hillsboro.
Pamlico Dr. D. A. Dees Bayboro.
Pasquotank Dr. H. T. Aydlett Elizabeth City.
Pender Dr. E. H. Bradford Burgaw.
Perquimans Dr. T. S. McMullen Hertford.
Person Dr. W. T. Long Eoxboro.
Pitt Dr. W. M. Fountain Greenville.
Polk Dr. Earl Grady Tryon.
Eandolph Dr. J. V. Hunter Asheboro.
Eichmond Dr. W. P. Webb Eockingham.
Eobeson Dr. W. A. McPhail Lumberton.
Eockingham Dr. Samuel Ellington Wentworth.
Eowan Dr. M. L. Smoot Salisbury.
Eutherford Dr. E. B. Harris Eutherfordton.
Sampson Dr. A. M. Cooper Clinton.
Scotland Dr. Peter McLean Laurinburg.
Stanly Dr. J. F. Laton Albemarle.
Stokes Dr. J. W. Xeal Walnut Cove.
Surry Dr. J. E. Woltz Dobson.
Swain Dr. A. M. Bennett Bryson City.
Transylvania Dr. Goode Cheatham Brevard.
Tyrrell Dr. J. L. Spruill Columbia.
Union Dr. H. D. Stuart Monroe.
Vance Dr. E. F. Fenner Henderson.
Wake Dr. J. J. L. McCullers McCullers.
Warren Dr. M. P. Perry Macon.
Washington Dr. W. H. Ward Plymouth.
Watauga Dr. H. McD. Little Boone.
Wayne Dr. T. M. Bizzell Goldsboro.
Wilkes Dr. E. M. Hutchens North Wilkesboro.
Wilson Dr. W. S. Anderson Wilson.
Yadkin Dr. T. E. Harding Yadkinville.
Yancev Dr. W. B. Eobertson Burnsville.
Letter of Transmittal
JSTorth Carolina State Board of Health,
Office of the Secretary,
Raleigh, X. C, August 3, 1911.
His Excellency, W. W. Kitchen,
Governor of Xorth Carolina.
Sir:—Under the authority of Section 4137 of The Revisal of 1905, I
have the honor to submit the Biennial Report of the State Board of
Health for the years 1909 and 1910.
In making this report I desire to express the sincere appreciation of
the State Board of Health for your deep interest in the fundamental
question of public health, for the strong recommendation for the in-crease
in the State appropriation for this purpose contained in your
last message to the Legislature, and for your cordial co-operation un-stintedly
given at all times in assisting us in dealing with public health
situations of peculiar interest.
Very respectfully yours,
"W. S. Rankin,
Secretary and Treasurer.
Legislation by General Assembly of 1909
Chapter 389.
AN ACT TO PROVIDE DIPHTHERIA ANTITOXIN FOR INDIGENT
PERSONS SICK OF DIPHTHERIA.
The General Assembly of North Carolina do enact:
Section 1. That the North Carolina Board of Health is hereby authorized and
directed to arrange for a sufficient supply of diphtheria antitoxin for the treat-ment
therewith, free of charge, of indigent persons sick of diphtheria, and for
immunizing against infection such indigent persons as may be exposed to the dis-ease,
and to extend the facilities for making the diagnosis of the disease.
Sec. 2. That the said board of health shall keep on hand in the State Labora-tory
of Hygiene a supply of reliable diphtheria antitoxin, and shall distribute,
through the said laboratory, to the several counties of the State, whenever the
boards of county commissioners thereof shall request it, and shall notify the Sec-retary
of the State Board of Health that they will pay for the same upon presen-tation
of a bill, and shall designate the person or persons with whom it shall be
deposited. The antitoxin shall be furnished at the lowest figure obtainable for
a reliable preparation.
Sec. 3. That whenever a physician is called to a case of diphtheria in an indi-gent
person or one in immediate need and unable to pay for antitoxin, he may
obtain the same from one of the depositories or diphtheria stations by filling out
and signing in duplicate the blank requisition form to be supplied with the anti-toxin
by the said board of health, and presenting the same to the county superin-tendent
of health or any member of the county sanitary committee, or to such
person as the said county sanitary committee may appoint, who, after satisfying
himself as to the indigency of the person or persons for whom the antitoxin is
intended, shall approve and countersign in duplicate the requisition. The person
dispensing the antitoxin shall retain one copy of the requisition and shall mail
the duplicate promptly to the director of the laboratory of hygiene. He shall
also return to the said director all packages of antitoxin in his possession as soon
as they become out of date.
Sec. 4. The provisions of this act shall apply to cities and towns upon the same
conditions as it does to counties.
Sec. 5. That for carrying out the provisions of this act the sum of five' hundred
dollars annually is hereby appropriated.
Sec. 6. That this act shall be in force from and after its ratification.
Ratified this the 26th dav of Februarv, A. D. 1909.
Chapter 722.
AN ACT TO PROVIDE FOR THE REGISTRATION OF DEATHS IN MUNICI-PALITIES
OF ONE THOUSAND POPULATION AND OVER IN THE STATE
OF NORTH CAROLINA.
The General Assembly of North Carolina do enact:
Section 1. That all deaths that occur in cities or towns having a population
of one thousand or over by the last preceding federal census shall be registered
bv the clerks or other officials designated bv the board of aldermen or town com-
6 NORTH CAROLINA BOARD OF HEALTH.
missioners thereof, who are hereby constituted local registrars of deaths, within
three days after the occurrence of said deaths and before the bodies are removed,
interred or otherwise disposed of: Provided, that in cities or towns now having
satisfactory registration of deaths under their ordinances the health officer or
other official now acting as local registrar shall continue as such, but shall con-form
to the provisions of this act and to the regulations of the State Board of
Health adopted thereunder.
Sec. 2. That a certificate of death, of standard form, provided by the State
Board of Health, shall be filed with the local registrar by the undertaker or other
person in charge of the removal, interment or other disposal of the body of the
deceased person, and a permit shall be issued by said local registrar for such
removal, interment or other disposal of the body only after such certificate of the
cause of death, signed by the attending physician, or, in case there shall be no
attending physician, by the health officer, or, in case there is no health officer of
the city or town, by the local registrar, who shall give the medical cause of death,
as nearly as he can determine it, after full inquiry, in regard thereto, of the
householder in whose family the death occurred: Provided, that under no circum-stances
shall the local registrar sign the death certificate when there has been an
attending physician or there is a municipal health officer. No sexton or superin-tendent
of a cemetery in cities and towns having a population of one thousand
or over shall permit interment, and no railway company or other common carrier
shall transport a body of a deceased person whose death occurred in this State
unless accompanied by the local registrar's permit.
Sec. 3. That the local registrar shall number each certificate as received, record
it in a local register of deaths, and promptly by the fifth day of the following
calendar month send all of the original certificates to the secretary of the State
Board of Health, at Raleigh, who is hereby constituted State Registrar of Vital
Statistics. The said registrar, with the approval of the State Board of Health,
shall maintain in his office a bureau of vital statistics, preserve, index and com-pile
the original returns, and make copies thereof for legal or other purposes, as
may be necessary, which copies, when officially certificated, shall be prima facie
evidence of the facts therein set forth, in all the courts of the State, for all pur-poses
of this act. The State registrar shall prepare and distribute all blanks and
instructions necessary for the execution of this act, and shall see that the pro-visions
of this act are faithfully enforced; and the solicitors of the several dis-tricts
and the Attorney-General shall aid him, upon his request, and enforce the
penalty of the law, in case of its violation. Each of the said local registrars
shall be entitled to a fee of twenty-five cents for his service, under this section,
to be paid by the city or town.
Sec. 4. That any undertaker, sexton or superintendent of a cemetery, agent of
a transportation company, local registrar or other person who violates the pro-visions
of this act, and any attending physician who fails or neglects to certify
to the cause of death when the certificate is presented to him for the purpose, and
every local registrar who shall neglect to perform any of the duties required of
him by section three of this act shall be guilty of a misdemeanor, and upon con-viction
thereof shall be liable to a fine of not less than five nor more than fifty
dollars or imprisonment for not less than ten nor more than thirty days, and shall
also be liable to a penalty of twenty-five dollars in favor of any person who shall
sue for the same.
Sec. 5. The mayor of each city or town of one thousand or more inhabitants
THIRTEENTH BIENNIAL REPORT. 7
shall be responsible for the enforcement of this act in his jurisdiction. Failure on
his part to so enforce its provisions shall be a misdemeanor, and he shall be
liable to a fine of not less than ten nor more than fifty dollars; and it shall be
the duty of the solicitor of the judicial district in which the city or town is
situate, upon complaint of the State registrar or of the secretary of the State
Board of Health, to institute a criminal action for the enforcement of said fine.
Sec. 6. That this act shall be in force from and after its ratification.
Ratified this the 6th day of March, A. D. 1909.
Chapter 793.
AN ACT TO AMEND SECTIONS 3045, 3058, 3457, 4440, 4442, 4444, 4457, 44G0
AND 4508 OF THE REVISAL OF 1905, RELATING TO THE PUBLIC
HEALTH.
The General Assembly of North Carolina do enact:
Section 1. That section three thousand and forty-five of The Revisal of one
thousand nine hundred and five be amended by inserting after the word "method,"
in line twenty-eight, the words "scope and detail," and by adding at the end of
said section three thousand and forty-five the following: "Full reports, in dupli-cate,
of all such inspections shall be made promptly to the secretary of the State
Board of Health and their accuracy certified by the affidavit of the inspector or
such officer or person as the said secretary may direct."
Sec. 2. That section three thousand and fifty-eight of said Revisal be amended
by adding thereto, as subsections (a), (b) and (c), the following:
"(a) The State Board of Health shall have the general care and oversight of
all inland waters, and shall, from time to time, as it may deem advisable, cause
examinations of said waters and their sources and surroundings to be made, for
the purpose of ascertaining whether the same are adapted for use as water sup-plies
for drinking and other domestic purposes or are in a condition likely to
impair the interests of the public or of persons lawfully using the same, or to
imperil the public health. For the purpose aforesaid it may employ such expert
assistance as may be necessary. The said board shall make such rules and regu-lations
as in its judgment may be necessary to prevent contamination and to
secure such purification as may be required to safeguard the public health. Any
individual, firm, corporation or municipality, or the person or persons responsible
for the management of the water supply, failing to comply with said rules and
regulations shall be guilty of a misdemeanor, and upon conviction shall be fined
or imprisoned, or both, at the discretion of the court.
"(6) The said board shall from time to time consult with and advise the boards
of directors of all State institutions, the authorities of cities and towns, corpora-tions
or firms already having or intending to introduce systems of water supply,
drainage or sewerage as to the most appropriate source of supply, the best prac-tical
method of assuring the purity thereof or disposing of their drainage or
sewage, having regard to the present and prospective needs and interests of other
cities, towns, corporations or firms which may be affected thereby. All such
boards of directors, authorities, corporations and firms are hereby required to give
notice to said boards of their intentions in the premises, and to submit for its
advice outlines of their proposed plans or schemes in relation to water supply and
8 NORTH CAROLINA BOARD OF HEALTH.
disposal of sewage; and no contract shall be entered into by any State institu-tion,
city or town for the introduction of a system of water supply or sewage
disposal until said advice shall have been received, considered and approved by
said board. Violation of the provisions of this subsection (5) shall be a misde-meanor,
and upon conviction those responsible therefor by neglect of duty shall
be fined not less than fifty dollars nor more than two hundred dollars, at the dis-cretion
of the court.
"(c) That for the purpose of carrying out the general provisions of the said
section three thousand and fifty-eight, as set forth in subsections (a) and (6),
every municipal or private corporation, company or individual supplying or au-thorized
to supply water for drinking or other domestic purposes to the public
shall file with the secretary of the State Board of Health, within ninety days
after receipt of notice from said secretary, certified plans and surveys, in dupli-cate,
pertaining to the source from which the water is derived, the possible sources
of infection thereof, and the means in use for the purification thereof, in accord-ance
with the directions to be furnished by the said secretary. Failure to file
said plans and surveys, as required in this subsection (c), shall be a misde-meanor,
and upon conviction those responsible therefor by neglect of duty imposed
thereby shall be fined not less than fifty nor more than one hundred dollars, at
the discretion of the court ; and every delay of one calendar month after the expi-ration
of the said ninety days shall be a separate offense."
Sec. 3. That section three thousand four hundred and fifty-seven of said Re-visal
be amended by adding thereto as subsection (a) the following:
"(a) That for any violation of this section or of the laws relating in any way
to the public health it shall be the duty of the solicitors of the several judicial
districts, upon complaint of the board of health, or of any of its officers, or of
any individual injured or likely to be injured, to institute a criminal action
against the person, firm, corporation or municipality charged with such violation
in their respective districts, and prosecute the same."
Sec. 4. That section four thousand four hundred and forty of said Revisal be
amended by striking out all after the heading and substituting in lieu thereof the
following: "The State Board of Health shall have a president, a secretary (who
shall also be treasurer) and an executive committee, said executive committee to
have such powers and duties as may be assigned it by the board of health. The
president shall be elected from the members of the board and shall serve six
years. The secretary-treasurer shall be elected from the registered physicians of
the State and shall serve six years. The executive committee shall be composed
of the president and the engineer member of the board, ex officio, and one other
member of the board, to be elected from those composing it. The executive office
of the board shall be in the city of Raleigh and the secretary shall reside there.
The secretary shall be the executive officer of the board, and shall, under its
direction, devote his entire time to public health work and shall be known as the
State Health Officer. He shall receive for his services such yearly compensation
as shall be fixed by the board, not to exceed three thousand dollars and his actual
traveling and hotel expenses when engaged in the work of the board. The board
may in its discretion elect as a special assistant to the State Health Officer, for
the anti-tuberculosis work, the Secretary of the State Association for the Preven-tion
of Tuberculosis, at an annual salary not to exceed six hundred dollars. The
members of the board shall receive no pay, except that each member shall receive
four dollars a day and necessary traveling and hotel expenses when on actual duty
THIRTEENTH BIENNIAL REPORT. 9
in attending the meetings of the board or of the executive committee or in pursu-ing
special investigations in the State; but when attending important sanitary
meetings beyond the limits of the State, the number of delegates thereto being
limited to one, in addition to the secretary, only actual traveling and hotel ex-penses
shall be allowed. These sums shall be paid by the treasurer on authenti-cated
requisition, approved and signed by the president."
Sec. 5. That section four thousand four hundred and forty-two of said Eevisal
be amended by adding thereto the following: "The executive committee shall meet
at such time as the president of the board may deem necessary, and he shall call
such meetings through the secretary."
Sec. 6. That section four thousand four hundred and forty-four of said Revisal
be amended by adding thereto the following: "Provided, that if the sanitary
committee of any county shall fail to elect a county superintendent of health with-in
two calendar months after the time set in section four thousand four hundred
and forty-one of said Eevisal for such election, the State Board of Health shall
appoint a registered physician of good standing, resident in the said county, who
shall serve the remainder of the regular two-year term, and shall fix his compen-sation,
to be paid by the said county, in proportion to the salaries paid by other
counties for the same service, having in view the amount of taxes collected by the
said county."
Sec. 7. That section four thousand four hundred and fifty-seven of said Revisal
be amended by striking out, in line two, the word "two" and inserting in lieu
thereof the word "six."
Sec. 8. That section four thousand four hundred and sixty of said Eevisal be
amended by adding thereto as subsection (a) the following:
"(a) Any householder in whose family there is to his knowledge a person sick
of cholera or typhoid fever, who shall permit the bowel discharges of such
sick person to be emptied without first having disinfected them according to in-structions
to be obtained from the attending physician or the county superintend-ent
of health, shall be guilty of a misdemeanor, and upon conviction shall be fined
not less than two nor more than twenty-five dollars or imprisoned not less than
ten nor more than thirty days. In cases where such undisinfected discharges are
emptied on the watershed of any stream or pond furnishing the source of water
supply for any public institution, city or town, the penalty shall be a fine of not
less than twenty-five nor more than fifty dollars or imprisonment for not more
than thirty days. And any physician attending a case of cholera or typhoid fever
who refuses or neglects to give the proper instructions for such disinfection as
soon as the diagnosis is made shall be deemed guilty of a misdemeanor, and upon
conviction shall be fined not less than ten nor more than fifty dollars."
Sec. 9. That section four thousand five hundred and eight of said Eevisal be
amended by inserting after the word "mention," in line eight, the words "or of
tuberculosis or typhoid fever."
Sec. 10. That this act shall be in force from and after its ratification.
Ratified this the 8th day of March, A. D. 1909.
10 NORTH CAROLINA BOARD OF HEALTH.
CHANGES IN PERSONNEL OF BOARD.
In amending section 4440 of The Eevisal of 1905 the General Assem-bly
of 1909 greatly benefited the cause of public health. This amend-ment
increased the appropriation for the Board from $2,000 to $6,000,
thereby, making it possible to further amend this section by requiring
the entire time of the executive officer of the Board to be devoted to the
public health work of the State.
In securing the favorable consideration of the General Assembly for
this extension of the work of the Board, former Secretary Dr. Richard
II. Lewis was chiefly instrumental. The act, by requiring the entire
time of the Secretary, made it necessary for the father of the bill to
culminate seventeen years of patriotic devotion to the State's greatest
asset, the health of her people, in his own official self-sacrifice. Along the
trail that this pioneer sanitarian blazed through discouragement, super-stition
and incredulity, his followers will endeavor to propel, with the
force of public opinion awakened to its civic obligations in the pre-vention
of unnecessary death, the life saving legislation of the future.
On March 30, 1909^ the State Board of Health met in a called meet-ing
in the office of the Secretary, at Raleigh. Dr. Lewis then explained
the amended law which required the executive officer to devote his
entire time to the work of the Board. After stating that he could not
afford to surrender his practice, he tendered his resignation as Secre-tary.
The Board, after insisting in vain upon the withdrawal of the
resignation, reluctantly accepted it. Dr. W. S. Rankin, of Wake For-est,
was elected to succeed Dr. Lewis. The present incumbent took
charge of his duties July 1, 1909.
Another change in the personnel of the Board was caused by the
untimely death of Dr. James A. Burroughs, of Asheville, on December
28, 1909. Dr. James E. Ashcraft, of Monroe, Avas elected by the Board
at Wrightsville on June 22, 1909, to fill the vacancy made by the death
of Dr. Burroughs. Colonel J. L. Ludlow, of Winston-Salem, whose
term of office expired in May, 1909, Avas reappointed by the Governor.
POLICY AND DUTIES OF STATE BOARD OF HEALTH.
In pursuance of the policy inaugurated by his predecessor, the present
Secretary has recognized the functions of the Board of Health as execu-tive
and advisory or educational. Of the two duties the last is of first
importance. Even the enactment of law, and much more the execution
of law, is dependent upon an approving public sentiment, and public
sentiment is the direct offspring of education. The Earl of Derby was
therefore correct in saying, "Sanitary instruction is even more im-portant
than sanitary legislation."
With the great amount of indifference to the enforcement of sanitary
laws on the part of the people, public health education, carried on
through all available agencies, press, special literature and platform, is
the most urgent, important and gigantic task of the Board. Neverthe-
THIRTEENTH BIENNIAL REPORT. 11
less, the will of the people as expressed through their representatives
makes the executive duties of the Board mandatory, and for this reason
they will be first considered.
Executive Functions of Boards of Health.
DIFFERENCE IN PRINCIPLE OF STATE AND LOCAL HEALTH LAWS.
The executive function of the State Board of Health consists in see-ing
to the enforcement of all State health laws, with the exception of the
Food and Drug Act. Health laws are and always will be divisible into
State and local laws—municipal and county health laws.
State health laws should control all those conditions affecting the
public health that are not limited to the jurisdiction of counties; that
is, that are inter rather than mira-county concerns. Those conditions
that affect the public health and that conform to this principle are
sanitary control of watersheds, the law requiring the registration of
deaths, the sanitary supervision of State institutions and the enforce-ment
of quarantine.
The reasons for this are perfectly clear. The only available water
supply of a town may be taken from a river that flows through another
county before reaching the one in which the town supplied is located.
Under such conditions, the necessary, just and only protection of the
purity of such water supply must be furnished by the State. The same
thing holds true for the law requiring the registration of deaths. If
each county had its own system of death registration, there would be
no uniformity, and, for comparison (and this is the only value of sta-tistics),
the records would be almost worthless. The sanitary super-vision
of State institutions that care for the afflicted and criminal, not
of one county but of the entire State, should be, as it is, under State
control.
A GRAVE DEFECT IN THE STATE HEALTH LAWS.
Contagion is no respecter of county boundaries, and the law controll-ing
the prevalence of contagious diseases should be enforceable through
State officials. Right here is one of the most serious defects in the
health laws of our State. At present quarantine, that is, the control
of contagious diseases, is entirely within the jurisdiction of the county
superintendent of health. An inefficient county superintendent of
health, elected and retained in office by a responsible board of county
commissioners, may neglect or refuse to quarantine or disinfect until an
epidemic in his county spreads and involves other contiguous and even
distant counties. In this way it is in the power of a board of county
commissioners to permit their county to become a hotbed for the dis-semination
of disease, a public nuisance, and an expensive neighbor to
sister counties and even other States. Under such conditions the State
at present is powerless. A large number of appeals from county super-intendents
of health to the secretary of the State Board of Health ask-ing
protection for their counties against contagion turned loose through
ignorance, indifference, or deliberate political play of moral weakness
to ignorant popular favor, are now on file in the office of the secretary.
12 NORTH CAROLINA BOARD OF HEALTH.
\
To these appeals we were, under our present quarantine law, debarred
from extending the necessary assistance.
A bill will be introduced in the present General Assembly to give the
State authority to enforce the quarantine laws, making it possible
thereby to protect the majority of intelligent, health-loving counties
from a few county health governments remarkable for lax quarantine
enforcement.
PRESENT STATE HEALTH LAWS.
The present enforceable State health laws are : The law requiring
the registration of deaths in towns or cities with a population of 1,000
or over, according to the last decennial census; the law relating to the
inspection of State institutions ; the law requiring the distribution of
diphtheria antitoxin to the indigent sick of diphtheria ; the law requir-ing
the appointment of a county superintendent of health when this
duty is not performed by the county sanitary committee; the law per-taining
to the sanitary control of public water supplies and the law
governing the work of the State Laboratory of Hygiene.
THE VITAL STATISTICS LAW.
To the health officer vital statistics are what the chart and compass
are to the mariner. Without them he knows not whence he came nor
whither he goes.
By vital statistics he is warned against danger. A timely warning,
an opportune application of the ounce of prevention, and many lives
are saved. For example, the vital statistics of a certain town show that
that town has twice the average death rate of other towns in which the
same climatic conditions prevail. This fact, but for these statistics,
would escape notice, for people die slowly, and neighbors, without some
comparative record, would regard their deaths as natural. An inves-tigation
follows the disclosure of these statistics, and the cause of this
increased death rate is discovered ; the cause is then removed and proper
precautions are taken to prevent its continued morbid effect and the
loss of many lives is prevented.
By vital statistics the health officer's course—progression or retro-gression—
is both indicated and measured. Some measure of supposed
sanitary value is put into operation. Its value will be measured almost
wholly by the statistical returns. If it is without effect, the cost of
operating it will be saved; if it is life-saving, others may know and
take advantage of it.
By vital statistics justice often finds her way clear and travels
quickly, whereas, without them, she creeps along with difficulty or loses
altogether the indistinct trail of the murderer, abortionist, or suicide.
Without them the child labor law is often administered by an ignorant
or cruel parent. ~No birth registration, no efficient child labor laws.
Our vital statistics law, chapter 722, Laws of 1909, pronounced by
Chief Statistician Wilbur, of the United States Bureau of the Census,
to be the only practical vital statistics law in the South, has been in
operation since September, 1909. This authority and government ex-pert
on the enforcement of vital statistics laws made an inspection of
THIRTEENTH BIENNIAL REPORT. 13
the results of the enforcement of our vital statistics law through a per-sonal
visit and examination of the certificates filed in the office at
Raleigh, in the early part of April, 1910. It is encouraging to those
of us concerned in its execution to know that he was well pleased with
its enforcement. The approval of the execution of this law encour-ages
us to hope that North Carolina will at an early date he accepted
by the Federal Government as a registration State.
At present our vital statistics law applies only to cities and towns
with a population of 1,000 or over, according to the last decennial
census. This gives us a registration area containing about 450,000
people, or about one-fifth of our State's population.
THE LAW GOVERNING SANITARY INSPECTION OF STATE INSTITUTIONS.
This law has been faithfully executed. In every instance the inspec-tion
was made without previous notification, and the conditions found
may therefore be regarded as a fair index to the everyday conditions
obtaining in our State institutions. The official report of these inspec-tions
will be found on pages 85-92 of this report.
THE LAW REQUIRING THE DISTRIBUTION OF DIPHTHERIA ANTITOXIN.
In accordance with this act, passed by the Legislature of 1909, 67
counties and 8 cities have availed themselves of the opportunity of
obtaining antitoxin at a very reduced rate for their poor. The State
Laboratory of Hgyiene acts as a distributing depot, and ships the
antitoxin, on demand, to any point in the State. By the contract with
the manufacturers, the special rate can be obtained only for indigent
cases when paid for by the county or municipality. The benefits of the
act do not apply to that largest class of the population, the independent
poor, those who do not want to be classed with the indigent, yet can ill
afford to pay the high prices charged for diphtheria antitoxin. It is
therefore recommended that the General Assembly be requested to fur-nish
diphtheria antitoxin to its citizens free of charge or at least ar-range
to furnish it to all its citizens at actual cost. It is possible that
the latter arrangement could be made without a change in the law, and
it is recommended that a new contract be sought with this in view. It
may be desirable ultimately for the State to manufacture its own anti-toxin,
but meanwhile the same good can be accomplished at approxi-mately
the same cost if the General Assembly sees fit to buy all the anti-toxin
needed for its citizens.
A bill will be introduced in the next legislature asking for a change
in this law.
THE LAW REQUIRING THE APPOINTMENT OF A COUNTY SUPERINTENDENT
OF HEALTH.
The proviso in Section 4444, Revisal of 1905, as amended by the
General Assembly of 1909, authorizes the Secretary of the State Board
of Health to appoint a county superintendent of health in counties
where the sanitary committee have failed to elect that official. In only
one instance has it been necessary for the secretary to comply with this
proviso of the law during the last two years.
14 NORTH CAROLINA BOARD OF HEALTH.
THE LAWS RELATING TO THE PUBLIC WATER SUPPLY.
The laws governing the protection of public water supplies against
pollution requires the filing in duplicate by the superintendent of the
water company of certified plans and surveys of the watershed made in
accordance with instructions furnished by the State Board of Health.
These instructions are embodied in "Circular A," an exact copy of which
is reproduced on page 98 of this report.
The law protecting the public water supplies against pollution further
requires that a quarterly inspection and report of the sanitary condi-tion
of the watershed and all surface supplies be made in accordance
with reasonable rules and regulations of the State Board of Health.
In accordance with these rules and regulations the sanitary inspectors
of the different surface supplies are furnished with instructions for
making the inspection. These instructions are embodied in "Circular
B," an exact copy of which is reproduced on page 101 of this report.
In making the inspection of a watershed the inspector leaves at each
home a copy of "Circular C," which instructs the householder and family
in regard to their duties in the protection of the public water supply
through the proper sanitary care of their premises. This circular is
reproduced on page 108 of this report.
Finally, the inspector after having made his inspection in accordance
with "Circular A," and after having instructed the residents on the
watershed in accordance with "Circular C," makes out his report in
duplicate on "Form A," an exact copy of which is reproduced on page
110 of this report, and then mails these reports to the Secretary of the
State Board of Health.
In connection with the sanitary supervision of the public water sup-plies,
I feel that as the State health officer I should violate both my
sense of duty and my public trust if I failed to make grateful acknowl-edgment
of the cordial, untiring and almost unlimited assistance ren-dered
me in my efforts to protect the public water supplies by Colonel
J. L. Ludlow, of the State Board of Health. His able service has been
given so unstintedly to the public water supply interests that I feel that
it is a considerable imposition on the part of the State to accept these
services further without some material compensation.
The sanitary patrol and inspection of watersheds for the purpose of
preventing water-borne disease is reinforced in its purpose by the law
requiring monthly analyses of the various public water supplies. It
has never yet been necessary to apply to the courts to enforce the law
requiring water companies to send samples of their water monthly for
analysis, but the penalty for the enforcement of this law is so small
that Ave hope the General Assembly of 1911 will see fit to increase it.
Analyses to the number of 14,826 have been made in accordance with
this law from January 1, 1909, to December 31, 1910.
The law protecting public water supplies also applies to springs from
which water is sold either at summer or health resorts or in bottles. This
law requires that these springs shall pay a graduated tax or procure a
license, through which revenue the State Laboratory of Hygiene shall
be able to analyze the waters of these springs. The law further pro-
THIRTEENTH BIENNIAL REPORT. 15
vides that if any bottled water be found polluted in three successive
analyses, publication of that fact shall be made in the Monthly Bul-letin
of the State Board of Health. Very little trouble has been
experienced in the enforcement of this law. During the last two years
three bottled waters have been found polluted, and notice thereof given
to the public through the Bulletin.
Here I wish to call attention to the wide and beneficent scope of this
law. Those placing bottled waters on the market, knowing that sooner
or later some of the water will find its way into the State Laboratory
of Hygiene and there be analyzed, realize that if it is found polluted
and published through the Monthly Bulletin of the State Board of
Health, not only to the people of ISTorth Carolina but throughout the
United States, their business will be seriously injured. In this way this
law has a splendid influence in keeping commercial waters pure, not
only at the springs and bottling plants in North Carolina, but also
throughout the United States.
THE LAW ESTABLISHING THE STATE LABORATORY OF HYGIENE.
This law, Section 3057 of The Bevisal of 1905 as amended by the
Legislature of 1909, finds ample justification in the following detailed
statement
:
NUMBER OF SPECIMENS EXAMINED AT THE NORTH CAROLINA STATE LABORA-TORY
OF HYGIENE FROM MARCH 1908 TO DECEMBER 31, 1910.
1908
January
February
March. 62
April 104
May 114
June 141
July 183
August 227
September 271
October 201
November 171
December 189
1909
16 NORTH CAROLINA BOARD OF HEALTH.
Mississippi has just opened a laboratory, while Texas, Arkansas, Ken-tucky,
and Tennessee have no organized laboratories for work of this
character.
The direct appropriation to the Laboratory by the Legislature is
$2,000. The tax on water companies is approximately $4,000, thus
making the income of the laboratory $6,000. Eleven thousand six hun-dred
and forty-four different specimens were examined. The cost to the
State of each examination made in 1910 was 51 1-2 cents. Among the
specimens examined were 1,835 water analyses, each of which comprises
from five to twenty-five distinct chemical and bacteriological tests. If
each of these were estimated as separate tests the average cost would be
greatly reduced. Out of the above sum also 160 patients were given
the Pasteur anti-rabies treatment, as no appropriation is made for this
work.
OPINIONS OF ATTORNEY-GENERAL.
In executing the State public health laws it has frequently been
necessary to ask the advice of the Attorney-General. That official has
always given us the most cordial co-operation and it is impossible to
overstate our deep appreciation for his valuable opinions. A copy of
these opinions will be found on pages 68-84 of this report.
EDUCATIONAL FUNCTIONS OF THE STATE BOARD OF HEALTH.
Section 4437 of The Revisal of 1905 as amended by the General As-sembly
of 1909 reads as follows:
"The Board of Health shall take cognizance of the health interests of the people
of the State; shall make sanitary investigations and inquiries in respect to the
people, employing experts when necessary; shall investigate the causes of dis-ease
dangerous to the public health, especially epidemics, the sources of mortality,
the effect of locations, employments and conditions upon the public health. They
shall gather such information upon all these matters for distribution among the
people, with the especial purpose of informing them about preventable diseases."
The italics are ours.
This educational provision for the improvement of public health is a
most wise one. Out of education comes public sentiment ; through pub-lic
sentiment, law is both enacted and enforced. At present ninety per
cent of the work of the Board is of an educational nature. This work
has been carried on through the Bulletin of the State Board of
Health, through contributions to the newspapers, and through public
addresses.
THE BULLETIN.
The Bulletin has grown in circulation from 3,500 in January, 1910,
to 18,000 January, 1911, and with this increased circulation the size of
the Bulletin has been enlarged from a ten page to a seventy page pub-lication.
During the past four months, requests for the Bulletin have
averaged thirty-five daily. At present the entire ministerial, legal and
medical profession, about seven thousand out of the ten thousand school
teachers, and a large number of other wide-awake people throughout
the State receive this educational monthly.
THIRTEENTH BIENNIAL REPORT. 17
To give a wider field of usefulness to the Bulletin, a contributory
Board of Editors composed of the following gentlemen, have agreed to
assist in its publication
:
1. Governor W. W. KITCHIN, Raleigh, N. C.
2. Hon. A. H. ELLER, Winston-Salem, N. C.
3. Hon. E. W. SIKES, Wake Forest, N. C.
4. Hon. W. C. DOWD, Charlotte, N. C.
5. Mr. CLARENCE POE, Raleigh, N. C.
6. Mr. ARCHIBALD JOHNSON, Thomasville, N. C.
7. Rev. GEORGE W. LAY, Raleigh, N. C.
8. Dr. HENRY L. SMITH, Davidson, N. C.
9. Dr. FRANCIS P. VENABLE, Chapel Hill, N. C.
10. Dr. W. P. FEW, Durham, N, C.
11. Dr. WILLIAM L. POTEAT, Wake Forest, N. C.
12. Dr. F. L. STEVENS, West Raleigh, N. C.
13. Dr. CYRUS THOMPSON, Jacksonville, N. C.
14. Dr. CHAS. O'H. LAUGHINGHOUSE, Greenville, N. C.
15. Dr. L. B. McBRAYER, Asheville, N. C.
16. Dr. BENJ. K. HAYS, Oxford, N. C.
17. Dr. EDWARD J. WOOD, Wilmington, N. C.
18. Dr. WILLIAM DeB. MacNIDER, Chapel Hill, N. C.
19. Dr. H. A. ROYSTER, Raleigh, N. C.
20. Dr. J. L. NICHOLSON, Richlands, N. C.
This means that the Bulletin through a greater variety of expres-sion
and subject matter will be more attractive and more serviceable
than ever before. It, of course, would be impossible without great ex-pense
to republish the entire issues of the Bulletin during the past
two years in this report.
THE STATE PRESS.
The press of the State has been most cordial in its co-operation with
the Board for better public health. Always liberal in the use of their
columns for the public service, they have, in the assistance given us, even
exceeded their own enviable reputaton for generosity.
The State press in calling repeated attention to the fact that the Bul-letin
could be had for the asking, and that it was well worth a place
in the homes of our people, have had much to do with building up a
greater demand for that publication. During the months of July, Au-gust,
September, and October many of the papers of the State pub-lished
weekly articles on public health sent out from this office. To
conclude, the assistance of the press has been of inestimable value.
ADDRESSES.
During the last twelve months a number of public health addresses
—
fifty or sixty—have been delivered to audiences representing different
fields of activity. The Conferences of County Superintendents of
Schools for 1909 and 1910, the North Carolina Teachers' Assembly, the
North Carolina State Primary Teachers' Association, the Meeting of
Conductors of Teachers' Institutes, a number of Teachers' Institutes,
18 NORTH CAROLINA BOARD OF HEALTH.
the North Carolina Press Association, the Tri-State Medical Society,
the Wake County Medical Society, the Guilford County Medical So-ciety,
the North Carolina Society for the Study and Prevention of
Tuberculosis, the Carolina Municipal Association, the State Federation
of Women's Clubs, and many other gatherings of people have been ad-dressed
on the fundamental problem of public health. Through the
interest aroused in these various oganizations others have taken up the
study of public health problems and these have succeeded in interesting
many others.
THE ANTI-HOOKWORM CRLSADE.
Under the able direction of Assistant Secretary Dr. John A. Ferrell,
the public have been seriously and actively interested in a general cam-paign
against a disease the frequency of which probably totals all other
diseases combined.
Dr. Ferrell's report of the work accomplished is given in detail on
page 93 and a very superficial perusal of this report will warrant the
assertion that the work could not be in better hands.
THIRTEENTH BIENNIAL REPORT. 19
Meetings of the Board
Office of the Secretary,
Kaleigh, ]ST. C, March 30, 1909.
Called meeting. All the members of the Board present. The Presi-dent
called upon the Secretary to explain the object of the meeting. In
response he stated that the principal reason for calling the meeting was
that such action might be taken by the Board as was rendered necessary
by the amendment to the laws relating to the public health enacted at
the recent session of the General Assembly. For the information of the
Board the Secretary then read the four acts relating to the public health,
the titles of which were as follows
:
An Act to Amend Sections 3045, 3058, 3457, 4440, 4442, 4444, 4457, 4460 and
4508 of The Revisal of 1905, Relating to the Public Health.
An Act to Amend Section 3057 of The Revisal of 1905, relating to the State
Laboratory of Hygiene.
An Act to Provide for the Registration of Deaths in Municipalities of One
Thousand Population and Over in the State of North Carolina.
An Act to Provide Diphtheria Antitoxin for Indigent Persons Sick of Diph-theria.
He also called attention to the fact that the annual appropriation for
the support of the State Sanatorium for Tuberculosis had been in-creased
by the Legislature from $5,000 to $7,500, and that an additional
appropriation for permanent improvements of $15,000 a year for two
years had also been made.
Dr. Lewis then offered his resignation as Secretary and Treasurer, to
take effect June 30th, the last day of the month in which the fiscal year
ended. He gave as his principal reason for taking such a step the fact
that the new law required the Secretary to devote his entire time to
the cause of the public health and that he was unwilling to abandon his
regular profession—his life work. He expressed his regret at giving
up the work which had been for so many years largely a labor of love,
but felt sure that it was best both for the work's sake and for his own.
He explained to the Board that for some years he had realized that the
great importance of the work demanded all the time of a competent
Secretary with ample assistance, and believing the time to be auspicious
for a forward movement, he had prepared a bill which if enacted into
law, while legislating himself out of office, would bring this about. He
also stated that believing the successful prosecution of the work to be
dependent upon the qualifications in several respects of the new Secre-tary
and that a mistake in the selection of the man would be a mis-fortune
hard to remedy he had gone over in his mind the medical men
of the State and assured himself that such a man was available and that
if elected he would accept the position, before he wrote the bill. Hav-ing
expressed his gratification at tho fact that he would still continue
a member of the Board and his sincere appreciation of the unvarying
20 NORTH CAROLINA BOARD OF HEALTH.
kindness, courtesy and cordial support of the Board during his in-cumbency
of nearly seventeen years, he retired from the meeting.
Minutes by Dr. Way, Secretary pro tern.
Dr. Lewis resigned to take effect June 30, 1909, retiring from the
hall. The President placed his resignation before the Board and asked
their pleasure. Dr. Register expressed his great appreciation of the
splendid work of seventeen years and his regard for Dr. Lewis and had
felt that if he (Dr. Lewis) could be induced to continue he would ask
him to do so. He wished his appreciation of Dr. Lewis's great work
be recorded. Dr. Anderson reciprocated fully the words of Dr. Register.
Dr. Spencer moved that a committee composed of Drs. Register and
Thomas be appointed to confer with Dr. Lewis and ask if he can re-consider
his resignation and serve out his full term. Carried. This
committee through Dr. Thomas reported that Dr. Lewis felt compelled
to consider his resignation as final. Dr. Thomas eulogized Dr. Lewis
as one of the notably few men he had ever known fitted for the work.
On motion of Dr. Burroughs seconded by Dr. Spencer, Dr. Lewis's
resignation was accepted.
Dr. Burroughs moved that a committee of three be appointed by the
President at his convenience to prepare resolutions expressive of ap-preciation
for the annual session of the Board in June. Carried.
Dr. Lewis, returning, resumed his duties as Secretary. The chair
announced that nominations for Secretary and Treasurer to fill the
vacancy were in order. Dr. Lewis, prefacing his remarks by the state-ment
that he felt that he ought to say that Dr. Way had been his first
choice as his successor and that upon the assurance of the doctor that
while he felt a deep interest in the work he could not afford to give up
his lucrative practice and comfortable home, he had worked for and
found another good man, placed in nomination Dr. Watson S. Rankin,
Dean of the Medical Department of Wake Forest College, at a salary
of $3,000 a year. He declared Dr. Rankin to be in his. opinion a man
of character, ability, energy, enthusiasm and possessed of the altruistic
spirit so helpful in work of this kind and admirably fitted for the
position. The nomination of Dr. Rankin was seconded by Drs. Bur-roughs,
Register and Way, and he was unanimously elected.
Action on the election of an Assistant Secretary for the anti-tuber-culosis
work was upon a motion of Dr. Way, postponed until the annual
meeting in June.
The Secretary called attention to the fact that under the new law
one member of the Board must be elected to complete with the Presi-dent
and the engineer ex officio, the Executive committee. On motion
of Dr. Way, Dr. Lewis was elected to serve on the Executive Com-mittee.
On motion, the salary of Dr. C. A. Shore, Director of the Laboratory
of Hygiene, was increased from $2,000 to $2,500 a year; that of Miss
Daisy Allen, Chemical Assistant, from $75 to $90 a month, and that of
Miss Mabel P. Massey, Stenographer, from $50 to $75 a month, it
being understood that she was to give her whole time to the work of
the Board. All increase in salary to take effect July 1, 1909.
THIRTEENTH BIENNIAL REPORT. 21
Dr. Way, representing the Board of Health of Waynesville, filed with
the Board plans for a public water supply which had been approved by
the sanitary engineer of the Board. The plans were approved.
On motion, the Board adjourned.
Bichard H. Lewis, Secretary.
Battery Park Hotel,
Ashevtlle, N". C, June 15, 1909.
The Board met in annual session in the room of the Secretary, with
President Thomas in the chair. Those present were Drs. Thomas,
Anderson, Way, Spencer, Register, Burroughs, Col. Ludlow and the
Secretary.
The minutes of the last annual meeting at Winston-Salem and of the
called meeting held at Raleigh, March 30, 1909, were read and ap-proved
after the correction of the latter by the insertion of the follow-ing
resolution which had inadvertently been omitted
:
"Resolved, That His Excellency the Governor be requested to reappoint Col.
J. L. Ludlow as the Engineer member of the Board."
Unanimously adopted.
Drs. Ray and Robertson, of Yancey County, appeared before the
Board at the request of the Chairman of the Board of Commissioners of
that County to request the appointment by the Board of Health of a
Superintendent of Health for that county, as the County Sanitary Com-mittee
had failed to elect one. As the two months required by the
statute before action could be taken by the State Board of Health had
not expired, the matter, upon the motion of Dr. Spencer, was referred
to the Executive Committee.
The Secretary having called attention to the expiration of the term of
Dr. Way as a member of the State Board of Embalming, he was re-elected
for the full term of five years.
Col. Ludlow called attention to the menace to the public water supply
of the town of Greenville by the discharge of raw sewage into Tar river
by the towns of Rocky Mount and Tarboro and offered the following
resolution
:
"Resolved, That the Secretary of the Board shall give notice to the municipal
authorities of the towns of Rocky Mount and Tarboro that Section 3051 of The
Revisal of 1905 must be immediately complied with; and further, that in the
event that said towns shall fail to provide and put into operation such sewage
purification plants as said law requires within six months from this date, the
Secretary of the Board is hereby instructed to take such legal steps as may be
necessary to secure a restraining order from the courts of the State enjoining
said towns from further discharge of raw sewage into Tar River and to take
such steps as may be necessary to secure the conviction and punishment of
either or both of said towns and the authorities thereof for committing a
misdemeanor as defined and provided for, in the said public health laws of the
State of North Carolina."
This resolution was adopted.
22 NORTH CAROLINA BOARD OF HEALTH.
Col. Ludlow then called attention to the menace to the Raleigh water
supply by the town of Cary and offered the following resolution
:
"Resolved, That the Secretary shall give notice to the municipal authorities of
the town of Cary that the provisions contained in Section 3052 of The Revisal
of 1905 must be fully complied with immediately; and further, in the event
said authorities shall fail to comply with said Section 3052 within three months
of this date the Secretary is hereby instructed to take such steps as may be
necessary to secure the conviction and punishment of said town authorities for
committing a misdemeanor, as provided in said Section 3052 and in Section 3060."
This resolution was adopted by the Board.
The Engineer of the Board likewise set forth the danger of the con-tamination
of the public water supply of the town of High Point and
offered the following resolution :
"Resolved, That the Secretary shall give notice to the General Manager and
the Division Superintendent of the Southern Railway Company that in compliance
with the provisions of the Public Health Laws of North Carolina and more par-ticularly
of Section 3049 of The Revisal of 1905, the said railway company is
instructed to issue orders, and to secure the enforcement thereof, that all water
closets on trains shall be locked and disused between the depot of High Point, in
Guilford County, and the bridge crossing Deep River; and further, that the
casting from trains of sweepings from cars, dining car refuse, or other garbage
shall not be permitted between said points where the said railway traverses the
watershed of the High Point public water supply; and further, should this in-struction
and said laws be violated, that the Secretary shall take such steps as
may be necessary to secure the conviction and punishment of the said railway
company and the officers thereof for committing a misdemeanor, as provided for
in the Public Health Laws of the State of North Carolina. And further, that
the Secretary shall give similar notice and take similar action in other cases
where railways traverse the watershed of any public water supply within the
State whenever the knowledge of such condition may be brought to his atten-tion."
After considerable discussion the following substitute for the above
resolution, suggested by the Secretary and offered by Dr. Anderson, was
adopted :
"Whereas, The Southern Railway runs across the watershed of the public water
supply of the town of High Point and for a considerable distance quite close to
the bank of the stream of supply and the impounding reservoir and,
"Whereas, There is danger of infection of the said public water supply by the
infections of the passengers ; therefore, be it
"Resolved, That in compliance with Section 3047 of The Revisal of 1905 the
Southern Railway Company be, and it is hereby requested to have all water
closets locked between High Point and Deep River bridge."
Dr. Way was elected the delegate to the next meeting of the American
Public Health Association at Richmond and Dr. Lewis to that of the
Conference of State and Provincial Boards of Health at Washington.
Upon motion, the Executive Committee was empowered to exercise all
THIRTEENTH BIENNIAL KEPOKT. 23
the powers of the Board of Health in the time between the meetings of
the Board.
The President appointed Dr. Spencer and Col. Ludlow a committee
to audit the accounts of the Treasurer.
Upon motion of the Secretary his successor, Dr. Rankin, was invited
tc sit with the Board and take part in the proceedings. Accepting the
invitation the doctor expressed his appreciation of the honor done him
by the Board in his election as Secretary and Treasurer to succeed the
present incumbent and pledged his faithful service. Upon his inquiry
as to whether the Board or an individual would be expected to buy books
for the library of the Board, expressing his willingness to make the pur-chases
himself, Dr. Way moved—and the motion was carried—that
the Secretary be authorized to purchase such books and subscribe to such
journals relating to the public health as in his judgment might be
needed and the available funds would permit.
Upon motion of the outgoing Secretary, who agreed to look after the
office during the absence of his successor, Dr. Rankin was authorized
and requested to spend a month in investigating the practical methods
pursued by the executive health officers of such States as he might select
and in visiting the United States Hygienic Laboratory and the Bureau
of the Census, his traveling and hotel expenses to be paid by the Board.
Upon motion the Board adjourned to meet in conjoint session with
the State Medical Society tomorroAv at noon.
Richard H. Lewis, Secretary.
Annual Session of the Board of Health.
Asheville, 1ST. C, June 16, 1909.
The Board reassembled at 3 p. m. with President Thomas in the chair
and all the members present except Drs. Burroughs and Taylor.
In compliance with the amended law the Secretary nominated Dr.
C. A. Julian, the Secretary of the North Carolina Association for the
Prevention of Tuberculosis, for the position of Assistant Secretary of
the Board for Tuberculosis at a salary of three hundred dollars a year.
Dr. C. A. Julian was duly elected.
Upon the statement of the Secretary that Drs. E. J. Wood and H.
Bellamy, of Wilmington, had expressed a willingness to do research
work in the study of pellagra under the auspices of the Board they were
appointed a commission to undertake it.
Upon motion of Dr. Spencer, the Treasurer was instructed to pay the
traveling and hotel expenses incurred by Dr. Lewis as delegate to the
meeting of the American Public Health Association at Winnipeg,
Manitoba.
Upon motion the President appointed Drs. Way and Register a com-mittee
to draft suitable resolutions in regard to the retirement of the
present Secretary.
The Auditing Committee reported that they had examined the ac-counts
and vouchers of the Treasurer and found them correct.
Upon motion the Board adjourned.
Richard H. Lewis, Secretary.
24 NORTH CAROLINA BOARD OF HEALTH.
In the transcription of the proceedings from the rough notes of the
meeting of the 15th a sheet was inadvertently overlooked until after the
above was signed. The part of the proceedings referred to were as
follows
:
Upon motion of Dr. Way it was ordered that the Monthly Bulletin
of the Board be enlarged in expense and scope and that its mailing list
be enlarged as much as practicable.
Upon motion of Dr. Way the Secretary was requested to furnish the
Secretary of the Wake Medical Society a copy of the proceedings of
the Board at its called meeting on March 30, 1909, and of this session
for publication in the transactions of that society.
Upon motion of Col. Ludlow the State Superintendent of Public In-struction
was requested to require in the public schools not less than a
five-minute period daily to be devoted to some subject bearing on health
and the Secretary was requested to furnish the teacher with serviceable
literature. Richard H. Lewis, Secretary.
Conjoint Session of the North Carolina Board of Health
with the Medical Society of the State of North Carolina.
President G. G. THOMAS, Chairman.
Asheville, N. C, June 16, 1909.
The meeting was called to order by Dr. Thomas, of Wilmington,
Chairman of the State Board of Health.
Dr. Thomas : "This conjoint session marks a period in the history
of the State Board of Health of North Carolina, which to us is very
significant. It is the end of the service of Dr. R. H. Lewis, for so long
the efficient Secretary.
"Following Dr. Wood, the pioneer of sanitation in North Carolina,
he took up the work with zeal and enthusiasm, which he has guided and
carried on by his wonderful judgment to its present high state. To Dr.
Lewis belongs the spread of sanitary knowledge in the State of North
Carolina, and the present influence of the Board of Health in the com-monwealth.
"All of you are aware that these steps towards the commanding posi-tion
it now holds have been slow and faltering, but the State at large
has come to realize the fact that the State Board of Health has done
good work for it, and its recognition, I think, is thoroughly voiced in
the action of the last Legislature, in largely increasing the fund for its
support, at the suggestion of our Secretary, Dr. Lewis—which is the
prime evidence of the confidence which has followed his work, which is
as well based upon the character of the man. He has gained not only
our confidence and respect, but that of the gentlemen who represent
the different constituencies throughout the State.
THIRTEENTH BIENNIAL REPORT. 25
"I say, then, when this good man feels that he must lay down this
work,—not because he is feeble or infirm ; I assure you of the contrary,
it is because he can not relinquish his active professional work to take
up the work of the State Board of Health exclusively,—it is time to
feel grateful for the work he has done for the State and for the medical
profession." (Applause.)
Report of the Secretary read by Dr. Lewis.
KEPORT OF THE SECRETARY, MAY 20, 1908, JUNE 11, 1909.
Your Secretary, in this, his last report, is much gratified at heing able to
say that his last year of service has witnessed the greatest advance of the cause
of preventive medicine in our State, in a like period of time, since the establish-ment
of the State Board of Health. For several years he has realized that,
owing to the exactions of his private professional work, .the time he could- give to
the work of the Board was entirely inadequate. He believed also, that, owing
to the very small salary allowed the secretary, on account of the meager appro-priation,
no one else could be expected to give more attention to it and make a
proper living, and so he waited before taking action until, in his judgment, the
outlook was favorable for an attempt at a forward movement. Upon the assem-bling
of the last Legislature the conditions, in his opinion, justified making a
trial for better things. Consequently, having found a man whom he believed to
be well qualified for the position and having obtained from him a positive prom-ise
to accept an election, if tendered him by the Board, your Secretary prepared
a bill, while incidentally legislating himself out of office, as he could not afford
to abandon his private practice, that would provide the means for work far in
advance of anything heretofore attempted for the public health. The essential
feature of the bill was an increase of the annual appropriation from two to ten
thousand dollars, authorizing the payment to the Secretary of a salary of three
thousand dollars a year and requiring him to give his entire time to public
health work. While the Legislature cut down the appropriation asked for to
six thousand dollars, it still left an increase of 200 per cent and a sum sufficient
to secure all the time of a competent secretary, the one thing absolutely essential
to any marked progress.
As you already know, the present incumbent, at a call meeting on March 30th
last, tendered his resignation, which was accepted, to take effect July 1st, and
Dr. Watson S. Rankin, Dean of the Medical School at Wake Forest College, was
unanimously elected as his successor.
The public health laws were also materially and advantageously amended in
many other respects, particularly those sections relating to the control of public
water supplies by the State Board of Health, in the preparation of which latter
amendments, invaluable aid was rendered by the engineer of the Board, Col.
J. L. Ludlow.
Section 3057 of The Revisal of 1905, relating to the State Laboratory of Hy-giene,
was amended by specifically requiring analyses of drinking waters sold in
bottles or other packages and imposing upon those selling them an annual tax
graduated in proportion to the gross receipts from sales. While the. original act
imposed an annual tax of $G4 upon all individuals, firms and corporations selling
water to the people, it was found, upon investigation, that in many instances this
was out of proportion to the business done, and it was deemed both right and
wise to make the tax equitable and at the same time to make it perfectly clear
26 NORTH CAROLINA BOARD OF HEALTH.
that bottled waters came within the law. The necessity for analysis of this
class of waters was startlingly shown by analyses your Secretary had made in
the laboratory in the genera] cause of the public health and for the purpose of
supplying ammunition with which to meet an attack upon the law, threatened by
the president of one of the companies selling a water of this class. Of sixty-one
samples from twenty-nine springs thirty-two were found to be infected with colon
bacilli. Although the gentleman referred to passed away before the General
Assembly met, the information thus obtained was of service in securing the de-sired
legislation. The section was further amended so as to require analyses of
the waters of springs "maintained and treated as an adjunct to any hotel, park
or resort for the accommodation or entertainment of the public," and an annual
tax of $15 was imposed upon all such sources of water supply, with an addi-tional
tax on all waters sold therefrom in bottles, in accordance with the schedule
referred to above.
Probably the weakest spot in our sanitary legislation has been the lack of
reliable vital statistics. The only statistics we have had heretofore have been
those collected by some twenty-odd cities and towns in various and manifestly,
in some instances, very imperfect ways, and incomplete and inaccurate vital
statistics are practically worthless. A model vital statistics bill for States was
sent us by both the Bureau of the Census and by the American Medical Asso-ciation.
Theoretically, it was an excellent bill, and for densely populated, highly
organized communities it is doubtless practicable, but for our State, with its
large, widely scattered rural population, and one-third of that negroes, it would
have been little short of absurd. After a very careful consideration of the sub-ject
it was decided that any attempt at the collection of reliable vital statistics
holding out the least hope of success, for the present at least, would have to be
limited to incorporated towns. So, desiring that our statistics might fit in with
those of the United States Census Bureau, a request was made of Dr. Cressy L.
Wilbur, Chief Statistician, to have prepared for us a bill applying only to cities
and towns of one thousand population and over. Taking the bill he kindly and
promptly sent as a basis, it was modified to fit our conditions. After its passage
in its completed state it was very gratifying to learn from Dr. Wilbur that it
was the first practical vital statistics law to be enacted in the South, and, more-over,
that it contained a provision for the enforcement, new to him and in his
opinion valuable. This provision was placing the responsibility for carrying
out the law solely upon the mayor, and making him liable to a fine of not less
than $10 for failure of duty in this respect: and at the same time making it
mandatory upon the solicitor to institute a criminal action for its collection,
upon complaint of the State Begistrar or Secretary of the State Board of Health.
It really looks now as if vital statistics of real value, though necessarily partial,
were in sight.
The high price of diphtheria antitoxin being prohibitory to the poor, the pro-priety
of making provision for its supply free to indigent cases of the disease
should not be questioned by any humane person. The suggestion of the advisa-bility
of such legislation came from Dr. B. E. Beeves, of Alleghany County, in
a letter, accompanied by a tentative bill, to Senator B. L. Doughton, of the same
county. The suggestion was cordially received, and at his request Dr. Beeves's
bill was modified and amplified into the law as we now have it.
Another forward step was the increase in the annual appropriation for the
support of the State Sanatorium for Tuberculosis, from $5,000 to $7,500, and the
THIRTEENTH BIENNIAL REPORT. 27
appropriation of $30,000 for improvements. This institution, which is ideally
located, was opened for patients in November last, and promises to be of much
value in the campaign against tuberculosis.
The most gratifying and encouraging thing in connection with the health legis-lation
by the late General Assembly is that, with the exception of the cutting
down of the appropriation of ten thousand dollars asked for to six and an imma-terial
amendment to the bill relating to the Laboratory of Hygiene, requiring
reciprocity in the matter of analyses of bottled waters with other States having
similar laboratories and requirements, all the bills relating to the public health
in any way were passed without amendment and without a single vote in the
negative. This signifies a remarkable growth in favorable public opinion and
justifies the hope of more rapid progress in the near future.
As this report is made to the conjoint session of the State Board of Health
with the Medical Society, and as nothing is of more importance to the public
health than well-qualified physicians, reference to the strictly medical legislation
is in order.
A bill, prepared by the Board of Medical Examiners, the essential feature of
which was the requirement of a preliminary education equal to graduation from
a high school of all applicants for license, was introduced in the House by one
of its most influential members. The requirement was certainly a most reasonable
one, and, as a matter of fact, of special value to the prospective student of medi-cine
but it was bitterly fought with the usual demagogic arguments of "Medical
Trust," "poor boy," and, after three hot contests, was finally defeated by a
majority of one.
The amendment to the license law, authorizing the Board of Medical Exam-iners,
in its discretion, to modify the requirements of the law and to grant a
limited license, when the conditions in the neighborhood from which the applicant
came demanded it, met with no opposition. Sjjecial acts licensing certain physi-cians
had been introduced and the indications were that they would be passed.
To prevent this kind of legislation, which would mean in the end the practical
destruction of our license law, this amendment was suggested as a compromise
and accepted by the introducers of the bills. This action on the part of those
having the matter in charge has been criticised in some quarters, but it should be
said that a copy of the amendment was sent to every member of the Committee
on Legislation and of the Board of Medical Examiners and was approved or as-sented
to by all, with the exception of a single member of the Board of Medical
Examiners. Those on the ground and familiar with the conditions as they actu-ally
existed in the Legislature felt no doubt whatever as to its wisdom.
Before leaving the subject of legislation, acknowledgment should be made of
the valuable assistance rendered by Dr. Albert Anderson of the committee.
After nearly seventeen years of active and loving service your Secretary lays
down the work with regret, although he realizes that it is best for the work's
sake as well as for his own. He is conscious of many things left undone that
ought to have been done, and perhaps some things have been done that ought
not to have been done, but he has tried to be of some service to the State.
In conclusion, he wishes to express his deep and heartfelt appreciation of the
unfailing and unvarying kindness and courtesy he has received at your hands,
and to most cordially commend to you his successor, Dr. Rankin. Dr. Rankin
he believes to be a man of character, ability, energy, enthusiasm and possessed
of the altruistic spirit so helpful in work of this kind. If the profession in the
28 NORTH CAROLINA BOARD OF HEALTH.
State will hold up his hands and give him their cordial support and co-operation
he will do great things in the coming years for North Carolina.
SMALLPOX REPORT.
Counties.
THIRTEENTH BIENNIAL REPORT. 29
The amount of work accomplished by Dr. Shore, the director, and his two assist-ants,
Miss Allen, Chemist, and Mr. Kellogg, Biologist, when compared with that
of some other laboratories, is, to say the least, unusual. A perusal of the report
of the director, which is appended hereto, will show this. Twenty-three hundred
and ninety-two examinations of specimens of various kinds and the administra-tion
of the Pasteur treatment to eighty-three patients in addition, in one year,
by so small a force, is most gratifying. This could not have been done but for
the kindness of the United States Hygienic Laboratory in furnishing us the virus
free of charge. Not a case has died, and our records, so far, could not be bettered.
In January last the Laboratory was moved to very commodious quarters; it has
been thoroughly furnished with the most approved apparatus and manned by a
force as good as any, and we can confidently expect its increasing usefulness.
The following is the report of examinations made in the State Laboratory of
Hygiene from May 20, 1908, to May 20, 1909:
143 Examinations of feces
—
Positive. Negative.
Hookworm 65 50
Oxyuris vermicularis 1
Ascaris lumbricoides 2
Amoebe coli 2 1
Fly larvae 3
Taenia saginata 1
Tubercle bacilli 2 9
Blood 4 2
Cancer cells • • 1
277 Examinations of sputum for tubercle bacilli 108 169
271 Examinations for diphtheria bacilli 169 102
43 Examinations for malaria 9 34
135 Examinations for Widal reaction 56 79
18 Examinations for gonocoeci 7 11
65 Examinations of brains for rabies 47 18
2 Examinations, bacterial, of pus.
6 Differential leucocyte counts.
122 Specimens of urine, with a variety of bacterial and chemical determinations.
74 Examinations of pathological tissue, as follows:
Carcinoma 15
Chronic inflammation 19
Benign hypertrophies 14
Sarcoma 6
Chondroma 1
Colloid goitre 2
Tuberculosis 10
Pyaemia 2
Verruca 1
Necrosis 1
Doubtful (tissue not well preserved) 1
Placenta 2
2 Examinations of gastric fluid.
1,234 Examinations of water.
2,392 Total.
30 NORTH CAROLINA BOARD OF HEALTH.
Eighty-three patients received Pasteur treatment at this laboratory. Of these,
65 were bitten by dogs in which the disease was demonstrated either by micro-scopic
examination, inoculation experiments in laboratory or by subsequent death
of other animals from a bite; in 17 cases only a clinical history of rabies in the
attacking animal was obtained; in 1 the history was found to be erroneous and
treatment was discontinued; 13 of these cases paid for treatment and the remain-ing
70 were given free treatment. C. A. Shore,
Director.
Dr. Albert Anderson : "As a member of the State Medical Society,
I think some expression of appreciation ought to be made at this time
of Dr. Lewis's work as Secretary of the State Board of Health, and I
am very sorry I am not prepared to speak as the subject demands, for
what I shall say will be from my heart, and what I can remember of his
work, and not extensively said.
"I would be untrue to myself and untrue to the Medical Society not
to say that the North Carolina State Medical Society fully appreciates
and loves Dr. Lewis for the great work he has done as Secretary of the
State Board of Health.
"I am old enough to remember the work of his predecessor, and re-member
when be took charge of this work as Secretary of the Board.
"Dr. Lewis went into it with intelligence, with love and with en-thusiasm.
I have been somewhat in touch with his work from the be-'
ginning. I know how wisely he has planned and how enthusiastically
he has executed his work in every advanced movement. I know, in the
first years of his service, that he planned for large things, and for the
universal good of the people.
"I had the honor to be appointed to take instruction in the Govern-ment
Laboratory, to do some water analyses, many years ago, at his
suggestion, and while my service was small and insignificar* it started
the work that has been more intelligently and wisely done si: je I quit.
"In connection with Dr. Bate, we tried to render the best service that
we could, as beginners, and after we stopped the work was taken up by
the State Laboratory of Hygiene and carried on by better trained men.
Finally the State Board of Health, through Dr. Lewis, secured Dr.
Shore, who stands, I suppose, equal to any man in his work, by long
training and intelligent service that he is now rendering to the State.
"The prospect for State preventive medicine is good, and not only
the Medical Society, but the State of North Carolina, will ever owe Dr.
Lewis a debt of gratitude. He has made history that will never be for-gotten,
and I feel that it would be unjust to ourselves not to say that
we appreciate his services and will always love him for what he has
done in the spread of a better general knowledge of hygiene and pre-ventive
medicine in the State."
Dr. F. R. Harris, Henderson : "I desire to say what I can in refer-ence
to Dr. Lewis. I am not a speaker, but I have a great deal in my
heart to say. I say this because I think preventive medicine in the
State is the most important field, as I see it today, and I want to en-dorse
what Dr. Anderson has said and, furthermore, to endorse Dr.
Shore.
THIRTEENTH BIENNIAL REPORT. 31
"We had an outbreak of diphtheria last season, and I had occasion
to send many specimens to him, and I want to say that the reports that
Dr. Shore made were in accord with the clinical picture, and I believe
they were correct, and he has my confidence, and I desire to commend
him for his work."
Dr. J. T. J. Battle : "I am one of a committee of three appointed to
draft suitable resolutions to express, in some slight degree, the high
esteem in which the Society holds Dr. Lewis, and for the great work
he has done for the Society and for the State."
The Chairman asked all who were in favor of the above to signify
it by rising vote, and the motion was unanimously carried.
Dr. W. S. Rankin : "Mr. President : If I may interrupt for just a
word: I feel that it is a little out of place for me to express myself
here, and I am absolutely unable to express my admiration of Dr.
Lewis's able work in North Carolina. I think that the spirit that has
governed and directed this work is the true altruistic spirit, and I feel
that Dr. Lewis is a greater man than we North Carolinians recognize.
I know that the public health workers of the United States look up to
Dr. Lewis as one of the greatest authorities ; as one of the originators
of public health movements. My slight acquaintance with these men
has convinced me of this fact. I know that Dr. Lewis is a national
figure in hygiene (applause), and has not received the appreciation at
home that he has received abroad.
"In taking up his work the highest ambition that I can cherish is
that I may wear the cloak that he lets fall, half as well as he has worn
it." (Applause.)
Dr. Stiles, being asked by the Chairman for remarks, said
:
"First of all I would like to endorse this resolution offered in regard
to Dr. Le7-is, but I have a delicacy in speaking, as I am an outsider.
"I endo/se, however, the regret the physicians of this State feel in
having Dr. Lewis retire, and this is seconded all over the country. I
have heard many expressions of regret that he was going to give up the
office of Secretary. It is generally recognized, however, that he has se-lected
a good man as his successor.
"To turn to another subject that I was discussing with Dr. Lewis, just
before the meeting came to order ; it was understood that several gentle-men
were going to speak on sanitary matters, and I suggested that when
they spoke we might take up the question of the sanitary privy, so
necessary in this State.
"I think, perhaps, Mr. President, what I have to say on the subject
would come in better after these gentlemen have read their papers, and
I therefore ask that you let me present later what I have to say, after
these papers have been read."
Dr. Lewis : "Mr. President : I would like to announce that there will
be a meeting of the State Board of Health in room 123 at a quarter of
three o'clock, for the purpose of finishing certain work not attended to
on yesterday. There will also be a meeting of the County Superin-tendents
of Health in the tea room at 3 :30, for the purpose of forming a
3
32 NORTH CAROLINA BOARD OF HEALTH.
State organization. I hope these gentlemen will attend, so that we may
have a quorum.
"I desire to say that we have had one hundred and one cases in which
persons have been bitten by rabid dogs since June last, and we have se-cured
from those persons who were able to pay $831.40—the fifty-dollar
fee—for the support of the laboratory."
The Board then adjourned until a quarter to three o'clock.
RESOLUTIONS ADOPTED BY THE STATE MEDICAL SOCIETY ON THE
RETIREMENT OF DR. RICHARD H. LEWIS AS SECRETARY OF THE
BOARD OF HEALTH.
Whereas, Our former and most efficient secretary of the Board of Health, Dr.
R. H. Lewis, has decided it necessary to resign from the position; and whereas,
for the long period of seventeen years of most arduous and difficult labor, he has
accomplished so much, by unfaltering zeal and devotion, for the upbuilding and
the honor of the profession, both of the State of North Carolina and the nation;
and whereas he has so carefully safeguarded the people against the threatened
inroad of disease as to save innumerable lives, the suffering incident thereto, and
great pecuniary loss; and whereas, during these strenuous years, we have seen
and appreciated the results of his great labors: now, wishing to express the
esteem in which he is held, not alone by the profession, but the laity, be it
hereby
Resolved, first, That this Society express its conviction that he has done more,
both in his official and individual capacity, than would have been possible for
any other one to have done.
Resolved, second, That we with reluctance accept his resignation, realizing that
we lose in some measure his great capabilities and far-reaching influence.
Resolved, third, That he, having been such a potent factor with the Legislature,
has saved us from impending adverse legislation and secured such salutary meas-ures
as are responsible for our present advanced position in sanitary work.
Resolved, fourth, That we earnestly implore him to give us yet his wise counsel
and help in time of difficulty and threatened legislation.
Resolved, fifth, That it is our sincere wish and prayer that he, having done
so much for sanitation and the health of others, may himself be blessed with
many future years of vigorous health and abundant enjoyment of the blessings
and happiness of life.
AN APPRECIATION.
In the retirement of Dr. Richard H. Lewis as their secretary, the State Board
of Health has lost a most efficient officer and the public a most devoted servant.
Dr. Lewis's tenure of office has bridged an important stage in the development
of public health work. Our understanding of the true nature of communicable
disease had its beginning in the discovery of Van Loewenhoek, a lens polisher,
of Delf, Holland, in 1G83. From its beginning, in that year, to 1850, the idea
that minute germs caused disease was but a theory, and but little more than
theory, supported by only circumstantial evidence, till 1880, when Robert Koch
transformed the theory into a scientific fact, and in so doing laid the sure foun-dation
for preventive medicine and public health. For the next ten years these
new facts filtered slowly through the medical profession, reaching the general
public about 1890, when the public began to grasp the true meaning of preventive
medicine.
THIRTEENTH BIENNIAL REPORT. 33
As Dr. Lewis was elected secretary of the Board of Health in 1892, the begin-ning
of his official life was coincident with the real beginning of preventive medi-cine.
It therefore became his task to nurse this great movement in its early and
tender years, in the years so important to future development, when the founda-tion
so essential to what is to follow is being laid. How well he has performed
this task is not for the writer to say, for on this question the present status
of public health in North Carolina and the best public health authorities in
America have handed down an opinion.
As the present condition of public health in North Carolina is largely the
result of Dr. Lewis's labors, in conjunction with the Board of Health, it may be
taken as the best evidence of his ability as a sanitarian. His best work is prob-ably
recorded in the statute books of the State. With the exception of the act
establishing the State Sanatorium for Tuberculosis and an act separating the
tuberculous prisoners from the well, he either drew up entirely or materially
modified before introduction all the laws bearing on public health, and was
active in securing their passage by the various Legislatures. In this connection
credit is due Col. J. L. Ludlow, the able sanitary engineer of the Board, for
preparing the sections in the amendment to The Revisal of 1905 adopted by the
last Legislature, giving the Board more power in controlling public water sup-plies
and in suggesting the advisability of analyzing the waters of springs at
resorts while open for the entertainment of the public. As long ago as 1902
North Carolina was recognized by the American Public Health Association as
one of four of the foremost States in water legislation. Dr. Lewis, with the con-currence
of the Board of Health, developed the Laboratory of Hygiene upon the
original plan of taxing all corporations or individuals selling water to the public
for its support, supplemented by an annual appropriation of $2,000 which he
secured from the Legislature of 1907. Another law very much to his credit is
our new vital statistics law. Dr. Creesy L. Wilbur, Chief Statistician of the
United States Bureau of the Census, has said of this law that it was "the first
practical vital statistics law enacted in any of the Southern States." As correct
vital statistics form the very basis of intelligent public health work, the value
of this law is at once evident. As law is the result of public sentiment, and
public sentiment the result of education, these laws are the result of an effectual
educational campaign for the improvement of public health. To this Dr. Lewis
has contributed through his editorial work in the Bulletin of the State Board
of Health and through many noteworthy publications and addresses. Among
these may be mentioned his "Drinking Water in Relation to Malarial Diseases,"
which started the change in Eastern Carolina in the domestic water supply from
open wells to driven pumps; his "Instructions for Quarantine and Disinfection";
his leaflets on typhoid and malaria ; his pamphlet on the prevention of tuber-culosis,
pronounced by good judges to be the best of its kind. A leading health
officer of the State of New York has said that 90 per cent of the anti-tuberculosis
work in that State was based upon Dr. Lewis's presidential address before the
National Conference of State and Provincial Boards of Health of North America.
The opinion of the great health officials of America of Dr. Lewis is shown by
the recognition they have accorded him in having made him president of both
the great national public health associations. In 1905 he was president of the
National Conference of State and Provincial Boards of Health of North America,
and in 1907 he was president of the American Public Health Association. It
is therefore \ery evident that the retiring secretary is a national figure in public
health work.
34 NORTH CAROLINA BOARD OF HEALTH.
When it is remembered that the small amount of $2,000, out of which clerk's
hire, etc., was to be taken, was all appropriated by our State, it can readily be
seen that the secretary's service was largely a labor of love. Forced on account
of this small appropriation to practice his profession, as an oculist, to earn a
living, he has given his resting hours to the service of his country, thereby show-ing
a self-sacrifice for public weal which should always be an inspiration to those
who follow him.
The writer fully realizes the embarrassment he takes upon himself in calling
attention to the high standard set by his predecessor, but a sense of gratitude
and duty, both as an individual and as a public official, will be satisfied with
nothing less. In assuming his official cloak I shall always be mindful of him
who wore it so worthily.
Meetings of Executive Committee
Office of the Secretary,
Raleigh, K 0., August 10, 1909.
At the request of the President, the Executive Committee was called
to meet at the office of the Secretary in Raleigh on August 10th, 1909
;
the object of the meeting being to consider the sanitary condition of the
State Sanatorium for the Treatment of Tuberculosis, the purification of
sewage at Rocky Mount and Tarboro, the purity of the Reidsville water
supply and to confer regarding Public Water Supplies, Circular B.
Dr. Thomas, President, called the meeting to order at twelve o'clock,
Dr. Lewis and Col. Ludlow being present.
Dr. Gordon, President of the Board of Directors of the State Sana-torium
for the Treatment of Tuberculosis, and Dr. Julian, Assistant
Secretary for Tuberculosis of the State Board of Health, appeared be-fore
the Board. Dr. Julian's report* of the sanitary condition of the
State Sanatorium was read, to which Dr. Gordon replied:
DR. GORDON'S STATEMENT.
"1. In regard to there being 'no matron or nurse in the institution,' the ex-planation
is: One reason that there is no matron and no nurse is that we have
no place for white help, no means for providing such a place and that it is abso-lutely
impossible to get a nurse or matron there and expect them to live with
the inmates of the institution.
"2. That the 'windows and doors are not provided with screens; the kitchen
and dining room swarm with flies' : Now, if you remember, the appropriation
made for this institution was one of the last bills passed by the last Legislature
and, if I remember correctly, I called a meeting of the directors perhaps early
in April. I was not at that meeting, being unable to attend. Since then we
have let a contract to Mr. Dew to screen the windows and doors and also
to provide screens to keep out rain, for every apartment in the institution. For
some cause he was very slow about it. He got part of the material there and
failed to get the remainder. The result was that the doors and windows were
never screened, that is, not until now. He is doing this work, now.
•See page 88 for Dr. Julian's report.
THIRTEENTH BIENNIAL REPORT. 35
'"I stayed at Montrose a few days, in order to ascertain the true conditions. I
ate in the dining room every meal, save one, while I was there, and there were
some flies, but I do not think there was the number of flies indicated by the
report here. I have certainly seen a great many more flies than I ever saw in
that dining room, and I did not note that there was an unusual number of flies
in the kitchen, although I had my own table and there may have been more flies
at the other table.
"The food was fairly well prepared, and while I was there the quality and
quantity was fairly good.
"3. 'Xo protection from rain,' etc.: I replied to that a while ago. Last year,
when the institution was opened, we curtained the building with heavy ducking
strung on wire so that during rains the curtains might be used to protect; but
the wind is so strong there that this arrangement was found to be a failure;
the ducking was blown off and it was finally taken down.
"4. I do not know when the floors had been cleaned. When I went down there"
I went to look after the installation of an electric plant. Dr. Brooks informed
me that he wanted to go away for a little rest, and asked me if I would look
after the patients. I told him that I would do the best I could. He met me at
Aberdeen. He did not go out to the institution with me, and told me nothing,
leaving me thus uninformed. I introduced myself to the patients, examined them
and saw them every morning and afternoon while I was there, in the meantime
looking after the building and installation of the plant. My observation is that
the cracks in the floors were unusually small, but it is possible that there was
some dust and dirt in them. The floors had not been swept the morning Dr.
Julian a.nd Dr. Stanton were there, and the beds, I suppose, had not been made
up that day.
"I think it but due to Dr. Brooks that I make this statement. The doctor has
found it impossible to get efficient help. One of the reasons is the reason already
stated, that he has no place to keep efficient help. No one would stay there
except inefficient help. He was exacting and insistent on their doing what he
said. The only way he kept his cook was by not paying him, so he could not go
away. He was dreadfully handicapped. His laundryman would not work for
him. When I got there I found the laundry had not been done for some time,
and Miss Lock told me she could not get it done. Miss Lock was a patient there
who had improved and was acting as matron. She told me that laundry work
was needed to be done badly. I asked whom she could get. She said it had been
done by a woman, but she had quit and could not be induced to return. I asked
regarding the cook, and she said she was a good washerwoman. Miss Lock said if
Charlotte, the cook, would do the laundry, she, with the help of William, would
do the rest, and so I made arrangements to have her wash the bed linen. I kept
Charlotte at that for a number of days. She laundered all the bed linen, except
what was then in use. I found the blankets had all been used and needed to be
laundered, so I sent for the party that had done laundry work for them since
the institution opened there, and she agreed to launder the blankets and the bed
linen, as well as to do the laundry work for the patients. I got her to do this
work until I left there. All the blankets had been used, but had not been used
an unreasonable length of time.
"5. 'Ventilation of the rooms bad' : We have a number of windows in the
assembly hall, and my observation was that the windows were nearly always
36 NORTH CAROLINA BOARD OF HEALTH.
open. At any rate this hall was used very little except for lavatory purposes
and writing. The patients sleep out of doors and live out of doors.
"The slops while I was there were kept thoroughly disinfected with bichloride
of mercury, and Dr. Brooks claims he has also used a large amount of bichloride
of mercury. While they did not look sanitary, they were all right.
"6. 'No bath tubs': Well, there are no bath tubs. We intend to put in shower
baths, instead, but have no money with which to put in any.
"7. 'There are two privies. There was no evidence that they have been cleaned.
No disinfectants have been found, no covers to stools, and odor offensive.' You
can not get any negro in that country to clean out one of these privies for the
institution, and the only means was to take a hand from the farm to do it. I
asked this man about the privies—he cleans them out—and he said he had been
intending to do it for several days. I asked him how long it had been since they
were cleaned out, and he said two weeks. I told him to clean them out, and Dr.
Brooks has since burned them down.
"8. There is nothing in this to reply to. He states it is crude and also thinks
it might have been more sanitary. We admit that : it could have been and should
have been. I think Dr. Brooks should have due credit. He had no efficient help
and no matron capable of filling the position, because no one would stay there.
No trained nurse would stay there. There was no place for colored help, the
only place being a pallet in the kitchen and one in the entry or butler's pantry.
I think Dr. Brooks should be credited with the fact that no provision had been
made by which he could keep efficient help, and he is certainly due the credit of
having appeared before the Executive Committee and insisted that the institu-tion
be closed during the hot weather and pending the improvements that were
contemplated. He insisted on it and one member of the Executive Board was
very much opposed to closing the institution, and I think the Executive Board
is solely to blame for its not being closed at the proper time.
"The whole thing in a nutshell is this: The Board of Directors, in their zeal
to demonstrate to the Legislature the good that could be derived from the in-stitution,
permitted the institution to be opened before it was properly equipped
—that is, before we had an institution. That was the mistake made, and we
feel that the members of the Board realize that now. At the same time we
thought it would help us in getting additional appropriation, without which we
could not have continued the work. (Dr. Lewis: "It did help.")
"If you will permit me, I should like to express my views in regard to this
report. It is no reflection on Dr. Julian. Dr. Julian did his duty as he saw it,
and I do not mean to reflect on anybody. At the same time it seems to me
that, as officials of the State and in the interest of the entire people of the State,
it would be unwise to make a public document of this report, believing, as I do,
that it will raise up and interfere, very materially, with any additional appro-priation
that may be asked for at the hands of the Legislature."
DR. JULIAN'S STATEMENT.
"In the first place, I desire to say that the condition shown us by Dr. Gordon
was just as good as it possibly can be and just as nice as his defense today.
When I was down there he gave me every opportunity to examine the institution.
He very kindly took us over the grounds; and I wish to say that the grounds,
elevation and soil are ideal, and that I know of no place in North Carolina that
would equal it for this work. These conditions are the best I have ever seen
THIRTEENTH BIENNIAL REPORT. 37
and the elevation I am sure is sufficient for the treatment of tubercular affections,
and in fact I think the possiiblities are really greater than in any other place in
North Carolina.
"I also wish to say, that there may be no prejudice to my report, that I have
had no communications from any one in North Carolina, layman or doctor, in
regard to this institution, except from Dr. Eankin, by letter, that I am not in
sympathy with any man or men that are trying to get the superintendency of
the institution, and that I really had expected to visit Montrose in the capacity
of the Assistant Secretary for Tuberculosis, and was glad to make this visit
officially, at the request of Dr. Rankin, our Secretary.
'•When I arrived at Aberdeen I found the little Rockfish and Aberdeen was in
such perfect condition sanitarily; the coaches were so clean, that I made the
remark to one of my friends that if we found the institution as well cared for,
I would be well pleased. I desire to say this, so that it will be understood that
I am not prejudiced.
"I also wish to say that I took the names of every person in the institution
before I told them my mission; inquiring into their habits and treatment, and
that except for Dr. Gordon, who was held in very high esteem, the treatment
was a joke among the patients. They spoke very highly of Dr. Gordon, but the
treatment was a joke.
"I looked around for appliances for examination. They had no microscope or
stethoscope. (Dr. Gordon: "I had that in my pocket." ) One patient complained
that he had been in bed two weeks with a temperature of 105 and that he had
only had his temperature taken by himself. That the doctor had not taken his
temperature all the while. Now, I have in my grip the names of every one who
gave me this information. I was told by one patient that from the time he
had entered until that day he had never had an examination, percussion, or aus-cultation,
or anything.
"Miss Lock was the only one that did anything at all in -he way of a matron.
She informed me that she was a patient, without salary, and was left to do as
best she could, without directions or orders, except what she received from Dr.
Gordon. It seems that they had no cows, and the first churning was done the
day I arrived at the institution. The butter and eggs were ordered from Aber-deen
and were usually stale. The other food was good. It appears that the
visits from the doctor in charge were only from Aberdeen and that he did not
remain at the institution. It is also claimed that the beds were changed from
one part of the porch to another by a negro man when it rained at night. One
patient informed me he had been there thirty-four days and, to his knowledge,
there had been no change of linen in that time. Others claimed that the linen
had not been changed for about two weeks. The beds on the porches were in dis-order.
They were turned helter-skelter, the sheets were dirty, and, as Dr. Gordon
remarked, after the sheets were used they were thrown up in a heap on an old
bed in one part of the porch in an unsanitary condition. It had rained the night
before and that part of the porch was wet and in an unsightly condition. A
patient informed me that he had accidentally turned his spit cup over on his
linen and that the only way he could get rid of it was to wash it out himself.
I observed the patients sitting around with rolls of toilet paper near by. They
would cough and expectorate into this toilet paper and then slip it into a bag,
and after that was filled it was disposed of in the fire. That I saw.
"A patient informed us that the porch had not been swept for a month and
38 NORTH CAROLINA BOARD OF HEALTH.
that the rooms had been swept once in two weeks, and that with a dry broom.
There was no cloth to moisten the floor. The sweeping was done by dry cleaning.
These were patients in advanced stages of tuberculosis, others without tempera-ture
and others with temperature and were then huddled in, and of course rein-fection
could occur with the sweeping, everywhere there was a dry sweeping.
"In answer to Dr. Gordon I should say the talk I had with him was satisfactory
and that I have the highest regard for him. He said Dr. Brooks had given him
no information in regard to the institution and he was obliged to go to work for
himself. He went out there handicapped. They were living there with no method
of ordering, except for this woman (Miss Lock), who was a self-appointed
matron.
"In regard to the cracks: They were no larger than ordinary cracks. They
were not filled like this floor, and all the dirt that could, accumulated in the
cracks. The floors should be waxed, and there is no excuse for neglecting this
matter, as turpentine and beeswax could easily be mixed together and the floors
waxed therewith.
"In answer to that part of Dr. Gordon's defense of Dr. Brooks, wherein he
states that he could not get a trained nurse, all that is Dr. Brooks's fault. The
report from Whitehaven and like institutions show that the danger of infection
of nurses and help is less in sanatoriums than in private houses.
"There is no reason why any physician should fear to sleep in any part of such
an institution, and there is no reason why any woman who has been trained as a
nurse should object to going to any kind of an institution if she is capable of
taking care of it.
"In regard to the kitchen and dining room, the use of the word 'swarm' does
look a little harsh, but they were preparing vegetables and the negro cook was
spreading them all over the table, and, in the absence of screens, there was no
reason why the flies should not be on the food; of course, on the cooked food as
well as on the raw. One patient told me that while one of them ate at the
table another would keep the flies off with a flybrush.
"I did observe a bed in the dining room, one in the pantry, and one in the
kitchen. These were without bedsteads; just piled down on the floor. A negro
man slept in the kitchen and a negro woman in the dining room.
"The privies are near the institution. The seat was some distance from the
ground and the accumulation of fecal matter extended from the ground to within
a few inches of the seat. The seat was without a cover, and no lime or other
disinfectant was seen around the privies.
"Besides the sanitary condition, the possibilities are so great that the insti-tution
must, in somebody's hands, or by your wise directions, be made an honor
to the State of North Carolina. The sanitary conditions of the institution are
inexcusable, It is inexcusable to have beds in the condition I found them in,
there. It is inexcusable to leave stools from early in the evening until the next
day at 12 o'clock, and this I saw.
"Suppose a patient comes there in the more advanced stage of tuberculosis
—
suppose he should have a hemorrhage at night. Who is to take care of patients
at night?"
Resolution : Introduced by Col. Ludlow.
"1st. That the Executive Committee endorse the activity and zeal on the part
of the Secretary and Assistant Secretary for Tuberculosis in their investigation
and complaint they have lodged against the State Sanatorium for Tuberculosis.
THIRTEENTH BIENNIAL REPORT. 39
That the Committee, after hearing this report and the discussions, does refer
the entire matter to the board of directors of the institution for their further
consideration and action. Further, that the Executive Committee, acting in its
official capacity as custodian of the public health of the State, the matter having
been referred to them officially, recommend to the board of directors of the in-stitution
that it shall not be opened for the treatment of patients until the con-templated
improvements have reached such a stage that the patients entering can
be properly cared for.
''Further: In reference to the complaint lodged by Dr. J. R. Williams, it is
likewise referred to the board of directors for their consideration and action."
The question of sewage disposal at Rocky Mount and Tarboro being
brought up, Mr. Battle said
:
"It is useless for us to discuss the matter with you on a scientific
basis.
"We insist that we are situated 68 miles above the only intake of a
public water supply. In view of that distance, the slow flow of the
stream, the size of the river at Rocky Mount and Greenville, and the
amount of sewage produced by Rocky Mount, your order was entirely
unnecessary and we insist that it be revoked. At the same time we know
the law,—no sewage shall be turned into a stream from which water is
taken below.
"The town of Rockv Mount, without any fault of its own, is entirelv
out of money with a floating debt of $20,000. It is absolutely impossible
for us to raise that amount of money, in any way. Our only recourse
would be to break the sewer entirely and keep sewage from running
into the river. This would cause a pestilence in the town, besides ruin-ing
our new $20,000 hotel. We can not consider giving up the sewerage
system. The whole matter of sewage purification is in an exceedingly
incoherent (?) state; as just shown by the Westinghouse agent. To put
our town to an expense that in a year or two would prove to be unwise
and inexpedient is unjust and oppressive.
"I would like to file with you the annual financial report of the city
of Rocky Mount (gives the Secretary a paper).
"What we wish to do, when our funds permit, is to install a septic
tank."
Mr. Bassett, for Rocky Mount, states financial condition of Rocky
Mount
:
"Our town has an increased demand of $8,000, and a decreased rev-enue
of $12,000, by reason of the prohibition law. The estimated flow
of sewage is 150 gallons per minute. The estimated flow of the river
is 1,275 gallons per minute. (Reads Section 3058 of Revisal of 1905.)
Greenville has filed no complaint. It is absolutely beyond the means of
Rocky Mount to install the system required by Colonel Ludlow. (Reads
a letter describing the system suggested by Colonel Ludlow.) Xo en-gineer
would require more of the country of England than Colonel
Ludlow requires of Rocky Mount. We will leave this matter in your
hands, absolutely assured that we will be dealt with justly and fairly."
40 NORTH CAROLINA BOARD OF HEALTH.
Mr. W. O. Howard, for Tarboro
:
"We feel that we are almost unable, in fact, that it would be almost
impossible for us to comply with your order. We are poorer than any
Eastern town. Tarboro has the highest tax of any Eastern North Car-olina
town, being $2.58 per hundred, for the town, county and State.
I am here to ask you to revoke your order for the present. With the
next meeting of the Legislature we may be able to comply. The system
demanded by Colonel Ludlow would require the expenditure of $68,000
and the annual running expenses would probably be $1,000. If you
can not revoke the order, do not require us to put in such an expensive
system. Greensboro has a septic tank which cost only $2,000. We cer-tainly
can not comply within six months. In order to do this, we shall
have to make some provision for levying more tax."
Colonel Ludlow : If Greenville's filter should fail to work one day,
the health of the town would be endangered. I can not possibly weigh
the danger to Greenville against the financial condition of Rocky Mount.
On motion of the Chairman, it was resolved that the time for the
installation of hygienic purification plants by the towns of Rocky Mount
and Tarboro be extended to July 1st, 1910.
REIDSVILLE.
Colonel Ludlow showed chlorin in this supply to be too high at all
times.
It was decided that the Secretary should visit Reidsville and look into
the matter of their water supply.
On motion the Engineer and the Secretary of the Board and the
Directors of the Laboratory of Hygiene were directed to make an in-spection
of the electrical purification of water and its practical appli-cation.
Raleigh, K C, February 9, 1911.
Dr. Jno. A. Ferrell, having been recommended to the Rockefeller
Sanitary Commission by Dr. Richard H. Lewis and Hon. J. Y. Joyner,
was requested by Dr. Lewis to meet Dr. Wyckliffe Rose, Administrative
Secretary of the Rockefeller Sanitary Commission in Raleigh, Feb-ruary
8th, 1910.
At this meeting Dr. Rose decided to recommend Dr. Ferrell's ap-pointment,
provided the State Board of Health, through its Executive
Committee, would approve the appointment.
The following day, Colonel J. L. Ludlow was called up by long dis-tance
telephone by Dr. W. S. Rankin, Secretary to the Board, and put
into possession of all the facts relating to Dr. Ferrell's appointment.
Thereupon he approved the appointment. Dr. Thomas later approved
the appointment by letter.
Dr. Ferrell was then appointed by the Rockefeller Sanitary Com-mission
as Assistant Secretary for the Eradication of Hookworm of
the State Board of Health. After arranging his local business he came
to Raleigh, taking charge of his official duties March 12, 1910.
THIRTEENTH BIENNIAL REPORT. 41
Annual Sessipn of the Board of Health
Wrightsville, N. C, June 21, 1910.
The annual session of the Xorth Carolina State Board of Health was
called to order by President Thomas.
Members present : Doctors Lewis, Anderson, Tayloe, Register, Way,
Spencer, and Colonel J. L. Ludlow.
Minutes of Asheville meeting June 15-16, 1909, were read. Colonel
Ludlow corrected the minutes by requesting that he be not referred to
as "Sanitary Engineer of the Board," but as a member of the Board.
The minutes were then approved.
The minutes of the meeting of the Executive Committee on August
10th, 1909, were then read and approved.
Letters, under dates of June 2 and June 4, 1910, from Jno. A. Wed-dell,
Clerk of Tarboro, and Hon. T. T. Thorne, Mayor of Rocky Mount,
were read. Both of these letters requested an extension of the time pre-viously
allowed the towns of Tarboro and Rocky Mount from July 1,
1910, to November 1, 1909. The Board, appreciating the cordial spirit
of co-operation expressed in these letters, and accepting in good faith
their statement to the effect that it was impossible for them to comply,
through no fault of their own, with the requirement for installing sew-age
purification plants by July 1st, passed the following motion intro-duced
by Dr. Lewis
:
"Moved that the towns of Tarboro and Rocky Mount be granted an extension
of time to January 1, 1911, for installing sewage purification plants."
As above stated this motion was carried. Dr. Lewis suggested that
the Secretary remind the above towns to submit to the Board plans of
the proposed purification plants according to Section 3058, Subsection
(b), before proceeding with their installation.
The minutes of the approval by the Executive Committee of Dr. Jno.
A. Ferrell's appointment as Assistant Secretary for the Eradication of
Hookworm were read and approved by the Board.
Dr. "Way officially notified the Board of the death of one of its mem-bers,
Dr. James A. Burroughs, and moved that a committee be appointed
to draft suitable resolutions regarding his death. Dr. Way was then
appointed by President Thomas a committee of one to prepare such
resolutions.
Dr. Anderson moved that Mr. H. W. Simpson be re-elected a mem-ber
of the Board of Embalmers. This motion was unanimously carried.
Dr. Lewis moved that the Board go into the election of a new member
to fill the vacancy made by the death of Dr. Burroughs.
Dr. Way nominated Dr. J. E. Ashcraft, of Monroe, for this position.
Dr. Ashcraft's nomination was seconded by Dr. Spencer and Colonel
J. L. Ludlow. Dr. Register made a number of commendatory remarks
concerning Dr. Ashcraft. Dr. Ashcraft Avas then unanimously elected.
President Thomas then appointed Colonel Ludlow and Dr. Spencer
an auditing committee to audit the accounts of the Treasurer of the
42 NORTH CAROLINA BOARD OF HEALTH.
State Board of Health and the State Laboratory of Hygiene. The ac-counts,
statements, checks, and receipted bilts were then turned over by
the Treasurer to Dr. Spencer.
Dr. Spencer moved that the meeting be adjourned. The motion
was carried.
W. S. Rankin, Secretary.
Conjoint Session of the North Carolina Board of Health
with the Medical Society of the State of North Caro-lina,
at Wrightsville, June 22, 1910.
President G. G. THOMAS, Chairman.
REPORT OF SECRETARY STATE BOARD OF HEALTH.
Mr. President, Members of the North Carolina State Board of Health, and Mem-bers
of the Medical Society of the State of North Carolina.
I have the honor to submit herewith my annual report as Secretary of the
North Carolina State Board of Health as authorized by Section 4442 of The Re-visal
as amended by the Legislature of 1909.
My first record is a sad one, namely, to note the death of the lamented Dr.
James A. Burroughs, a member of this Board and late President of this Society.
Dr. Burroughs heard the summons of our common adversary, and on December
28, 1910, fell in the front line of the battle of science against death. His death
leaves a vacancy on the Board of Health which should be filled at this meeting.
The most important, as well as the most encouraging, change that has taken
place since our last meeting is the continued and vigorous growth of the public
interest in the question of health. This growing interest finds expression through
several sources.
Medical inspection of schools, carried on during the last three years and in-cluding
schools in England and in various parts of the United States with an
aggregate of about one million pupils, has shown that 20 per cent of the children
have defective eyes, 5 per cent of them have defective ears, and about 10 per cent
defective throats. The large number of children examined and the extensive
geographical distribution of these statistics establish a condition that is general.
So large a number of physical defectives in the schools means the retardation of
the entire school; means a tremendous loss through the retardation of all the
children, and the inability of a large number of children to use what is taught
them ; means that many physical defectives are unjustly punished, whereby many
sweet dispositions are soured and many characters are twisted. These facts, to-gether
with the general growth of public health interest, have gone a long way in
causing the school people to recognize the fundamental value of health and in
making of them one of the strongest forces in the public health movement.
Through the deep interest of State Superintendent of Public Instruction
Joyner, your Secretary has addressed both the Association of County Superin-
THIRTEENTH BIENNIAL REPORT. 43
tendents of Public Instruction and the North Carolina Teachers' Assembly, in
addition to several teachers' institutes, on the question of public health. The
November issue of the Bulletin was a teachers' edition and dealt with the re-lation
of the public school to health. Four thousand North Carolina teachers
are on the mailing list of the Bulletin. In December your Secretary prepared
a pamphlet dealing with the construction and care of sanitary schoolrooms and
the examination of children by teachers for defective eyes and ears. The major
part of this pamphlet was taken from a silimar publication prepared several years
ago by former Secretary Lewis. This pamphlet was issued and distributed by
the State Department of Public Instruction. In February of this year another
pamphlet on the subject of tuberculosis was prepared by Assistant Secretary
C. A. Julian. This was published by the State Department of Public Instruction,
but, on account of some delay, it was thought best to wait until the next public
school year to distribute it.
While, at present, the study of sanitation and preventive medicine is not pre-scribed
in the public school course, many influences are at work toward this end.
The teachers are feeling the effect of the popular demand for health study, and
in many schools health is receiving attention in one way or another. I am led
to believe, from a recent conversation with State Superintendent Joyner, that
at the next meeting of the Board for the Selection of Text-books, some time dur-ing
the year 1911, the subject of sanitation and preventive medicine will be pre-scribed
for the public school system.
At the request of Superintendent Joyner, a series of sixty health talks, cover-ing
the subject of public health, will be prepared during the summer for the
public school teachers. The talks will be published in convenient form for the
use of the teachers, and distributed. The teachers will use them as the basis for
three ten-minute talks to the school each week on the subject of health.
In this connection I wish to call your attention to and ask your support for
the School Betterment Associations. These associations, now established and
active in many counties, are doing much for public health by insisting on better
sanitary conditions in and around schoolhouses.
Many physicians have made health addresses before schools and teachers' in-stitutes
during the last year, and, in this way, have contributed much to the
public welfare. Permit me to commend this practice to all those physicians
whose public interest is seeking a wider sphere of usefulness.
The churches, along with all other organized influences, have deepened their in-terest
in the question of health, and many pulpits have contributed largely to the
cause of more efficient and cleaner living as a means of better preparation for
the other life. In March of this year a special Preachers' Bulletin was issued
for Sanitary Sunday, April 24th. This Bulletin contained the endorsement, for
its use by the preachers of various denominations, of many of the leading clergy-men
in the State. I am sure this Bulletin was used by many of the pulpits, and
I desire here and now to make grateful acknowledgment of this fact.
The press of the State is showing its awakening sense of responsibility for
public health by more frequent expressions on this subject. Your Secretary had
the pleasure of addressing the Press Association on their relation to the public
health, at their recent meeting in this place. They seemed to be deeply interested
and promised their cordial cooperation with the State Board of Health for health
improvement. I am quite sure that the press is becoming seriously interested in
this problem, and their interest will go a long way toward creating a demand
for a better health administration, local and State.
44 NORTH CAROLINA BOARD OF HEALTH.
The American Tuberculosis Exhibit, under the direction of Mr. E. G. Routzahn,
has been at work in our State since March 15th. It has already given three ex-hibitions
of three weeks each, in the cities of Greensboro, Raleigh, and Winston-
Salem. It will go to Durham later this summer, and it is hoped that Charlotte
will secure the exhibit for the fall. The effect of this exhibit is to tremendously
augment the local health interest wherever it is given, and to create a general
interest in health in the surrounding country.
Last, but by no means least, of the organized influences that have seriously
interested themselves in better health is the State Federation of Women's Clubs.
At their recent annual meeting in Henderson your Secretary addressed them on
the subject of public health, and they expressed their deep concern in the cause
by passing resolutions emphasizing its importance and organized a Health De-partment
of the Federation. Mrs. W. N. Hutt, of Raleigh, was made chairman
of this department.
The Monthly Bulletin of the Board of Health has been increased in its
circulation from 3,500 to 11,500, and its mailing list includes all the doctors,
preachers, lawyers, and 4,000 of the 10,000 school teachers in the State. There
are, in addition, a number of other names on the mailing list. The Bulletin
also reaches most of the newspapers of the State.
The Legislature of 1909 passed three important public health measures: A
law relating to the control and care of public water supplies, a law requiring
the registration of all deaths occuring in towns or cities having a population of
a thousand or more at the last decennial census, and a law providing for the
distribution of diphtheria antitoxin to the indigent. Former Secretary Dr. Lewis
has already called attention, in the March (1909) Bulletin, to the nature of
these laws. All of them have been put in operation during the last year.
The law relating to water supplies requires the authorities of every public
water supply to file certified duplicate plans and surveys prepared according to
rules and regulations furnished them by the Secretary of the State Board of
Health. Of the 63 public water supplies of the State, 45 have complied with this
requirement. Eighteen have not complied, and the attention of the solicitor has
been called to the infringement of this law in the case of one company, the other
fourteen having rendered acceptable excuses for their delay. This law further
requires the authorities in charge of all public water supplies to make quarterly
ins